What Is a Fecal Transplant?

Fecal microbiota transplants — using feces donated from people with healthy guts — can help some people with hard-to-treat intestinal problems.

What is a fecal transplant?

The balance of microorganisms in your gut — known as your gut microbiome — is one key to health. The microbiome is a complicated system of microorganisms (including countless bacteria, viruses, fungi, and other organisms) that exist symbiotically within your digestive system and help support the rest of your body’s functions, including digestion and immune defense.

Because our feces contain those microorganisms, the feces of someone in good gastrointestinal health can be valuable, even life-changing, to another person with intestinal problems. This insight has led to fecal microbiota transplantation (FMT), which means doctors introduce a small amount of feces from a healthy donor into part of the gastrointestinal system of a patient with a seriously disrupted gut microbiome.

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Fecal transplant procedure

For the fecal transplant procedure, doctors insert a tube into the colon (much like performing a colonoscopy) to deposit fecal material from a donor. Only a small amount is used — between 50 and 100 grams, the equivalent to about 4 to 8 tablespoons. Far less often, freeze-dried fecal material is taken in capsules and, rarely, introduced via an upper endoscopy tube.

The use of fecal transplants is best established in patients infected with Clostridium difficile (better known as C. diff, for short), a sometimes lethal microorganism that causes contagious diarrhea.

The problem has increased sharply over several decades, especially among hospital patients. Relapses are increasingly common, too, with 20 to 30 percent of patients experiencing at least one recurrence two to four weeks after completing the standard treatment of broad-spectrum antibiotics, while others getting no relief at all. Some patients undergo emergency colectomies (surgical removal of all or part of the colon) and still have problems afterwards.

C. diff is especially vexing among the elderly, who are harder to treat. So, doctors got imaginative when looking for answers and turned to research about FMT.

An analysis of some of the earliest research involving randomized, controlled clinical trials, revealed fecal transplants resolved symptoms for 85 percent of the patients with recurrent bouts of C. diff and 55 percent of those who weren’t responding at all to other treatments.

As physicians became more skilled with using FMTs and the donated feces material became more rigorously studied and carefully chosen, the success rate improved even more.

Fecal transplant success

Researchers from Aarhus University and Aarhus University Hospital in Denmark (a country where around 3,000 people suffer from life-threatening C. diff infections each year) had to stop a double-blind study testing FMT versus standard antibiotic care for the infection.

The fecal transplant treatment was so quickly and obviously effective, it was unethical to continue with the study without offering the FMT to the other participants, the research team explained in The Lancet Gastroenterology & Hepatology journal.

The researchers also noted there are many indications FMT is likely an effective treatment for more than C. diff. It is being tested on a wide range of other diseases in which an imbalance of intestinal microbiota may be an important factor.

“At the moment, many studies of FMT treatment for various diseases are being carried out worldwide, with the most promising of these indicating beneficial effects in patients with inflammatory bowel disease and multi-resistant bacteria,” said Aarus University gastroenterologist and researcher Simon Mark Dahl Baunwall, MD.

Fecal transplant donation

Feces donors are now rigorously screened, after the U.S. Food and Drug Administration issued a warning about serious health problems reported in rare cases when fecal transplants resulted in recipients becoming infected from harmful antibiotic-resistant bacteria from donated feces.

In fact, there are now donor stool banks in the U.S., where young, healthy volunteers with a normal body mass index provide stool after undergoing thorough history taking, physical examination, and serum and fecal screening tests to make sure their feces is free of disease causing pathogens.

The nonprofit OpenBiome is a stool bank and research platform that works collaboratively with doctors, hospitals, and researchers to make FMT safe and affordable for patients suffering from recurrent C. diff infections and to explore FMT's role as a treatment for other diseases.

Transplants may subdue other pathogens resistant to many drugs, particularly vancomycin-resistant enterococci, or help treat inflammatory bowel syndrome, a common term for auto-immune conditions such as ulcerative colitis and Crohn's disease.

Some evidence suggests that introducing feces from lean donors to obese recipients can make overweight patients more sensitive to insulin — a much-desired result for people with diabetes.

What you can do

You can take steps to keep your microbiome healthy.

• Work with your doctor to use antibiotics only when medically necessary.
• Eat a lot of vegetables rich in fiber. They can help promote a healthy microbiome.
• Make a point to eat “prebiotics,” foods that promote healthy bacteria in your body. Prebiotics include asparagus, bananas, onions, garlic, cabbage, beans, legumes like peas and lentils, artichokes, apples, root vegetables, apples, and various kinds of bran.
• You might also try “probiotics” fermented with good-guy bacteria: yogurt, sauerkraut (fermented cabbage), kimchi (the spicy Asian cabbage), kombucha (fermented tea), or tempeh (fermented soybeans).  

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