5.2 Faecal transplant

You learnt earlier that IBS can be triggered by an episode of gastroenteritis by pathogenic bacteria, such as Clostridium difficile (C. difficile). Unfortunately, C. difficile is highly resistant to treatment, and can extensively colonise the gut which damages the health of the gut microbiome. A chronic C. difficile infection can have a devastating impact on the health of the individual.

One of the functions of the gut microbiome is prevention of colonisation of the gut by pathogenic bacteria, however in a C. difficile infection the individual’s own gut microbiota get overwhelmed. So, they may need help from another individual via a faecal microbiota transplant (FMT) to reestablish a healthy balance of bacteria in the gut.

Volunteers are rigorously screened for infections, gastrointestinal diseases, antibiotic use in the past 6 months and not being immunocompromised before donation of the faecal matter (Johns Hopkins, n.d.).

The screened and processed FMT is then delivered by one of four main routes:

• Colonoscopy – the most common method, where the donor faecal matter is distributed along the length of the large intestine.
• Upper endoscopy – typically only used if an individual cannot have a colonoscopy, but is less effective.
• Enema – donor faecal matter is placed in the rectum.
• Tablet – freeze-dried but live microbiota organisms.

While the idea of FMT may be challenging, the impact of recurrent C. difficile that is not responding to treatment can be debilitating. However, FMT results in an estimated 87-90% cure rate of recurrent C. difficile, so for most individuals it provides significant relief and improvement in their health (Gupta, 2016).