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Fecal Microbiota Transplant: We Know Its History, but Can We Predict Its Future?

      Fecal microbiota transplant (FMT), sometimes referred to as simply fecal transplant, is a process of transferring feces from one person to another to alter the fecal microbiome of the recipient for the purposes of treating certain diseases. The idea of fecal transplantation dates back to the 4th century CE, but consideration of its use for the treatment of Clostridium difficile infection (CDI) only began in the early 1980s.

      Brandt LJ, Aroniadis OC. An overview of fecal microbiota transplantation: techniques, indications, and outcomes [published online ahead of print May 2, 2013]. Gastrointest Endosc. https://doi.org/10.1016/j.gie.2013.03.1329.

      C difficile infection is one of the most common hospital-acquired infections and represents a major health problem in the United States.
      • Khanna S.
      • Pardi D.S.
      Clostridium difficile infection: new insights into management.
      Patients with recurrent CDI (RCDI) have an alteration in gut flora (dysbiosis). This alteration likely accounts for rates of RCDI of 10% to 20% after initial antibiotic treatment and recurrence rates as great as 40% to 65% in patients who have previously been treated for an RCDI episode.
      • Brandt L.J.
      American Journal of Gastroenterology Lecture: Intestinal microbiota and the role of fecal microbiota transplant (FMT) in treatment of C. difficile infection.
      Probiotic therapy, particularly using the yeast Saccharomyces boulardii in combination with high-dose antibiotic therapy, has been used for RCDI, although with limited success.
      • Surawicz C.M.
      • Brandt L.J.
      • Binion D.G.
      • et al.
      Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections.
      However, reintroduction of normal flora via donor feces is believed to correct the imbalance in gut microbiotic flora. On the other hand, antimicrobial therapy for CDI does not restore this imbalance and continues to alter the intestinal microbiome.
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      References

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