Fecal Microbiotica Transplantation for Treatment of Diarrhea
The Clostridium difficile bacterium causes serious intestinal conditions such as diarrhea and colitis. Clostridium difficile infection can cause many different symptoms, including watery diarrhea, fever, loss of appetite, nausea, and belly pain and tenderness.
People can develop a Clostridium difficile infection in several ways, including:
- When they become sick
- When they take antibiotics
- When they are in a setting, like a hospital, with Clostridium difficile spores
Fecal microbiotica transplantation (FMT, or stool transplantation) is a treatment for diarrhea that is caused by the Clostridium difficile bacteria. The treatment involves the transfer (through a processed mixture of stool) of “healthy” bacteria from a donor into the intestines of the patient (recipient). The idea is to restore the proper balance of bacteria in the recipient’s intestine so that he or she can fight infection.
Cleveland Clinic is considering FMT in patients who have a Clostridium difficile infection that has been caused by treatment with antibiotics. In order to be considered for FMT, the patient must have at least two stool samples that test positively for Clostridium difficile, even after treatment with antibiotics.
Before an FMT is performed:
- The patient will meet with the doctor and identify the donor
- The patient will give his or her informed consent for the procedure
- The patient and donor will meet with a Patient Financial Advocate
Not all insurance companies cover FMT. The cost of the FMT Financial questions can be discussed with one of our Patient Financial Advocates at 216.445.0158. The patient must pay all costs, including screening of the donor. To make an appointment, please call 216.444.7000.
The donor, a friend or relative, should be willing to take part in the FMT procedure. Potential donors will not be allowed to donate if there is a risk that they might transfer a contagious disease to the patient.
Donors will be tested for the following:
- Hepatitis A, B, and C
- HIV 1 and 2 (the virus that can lead to AIDS)
- HTLV 1 and 2 (viruses that can cause cancer)
- Clostridium difficile, parasites, and bacteria (including E. coli O157:H7) in the stool
In order to be able to donate, a potential donor must:
- Not have taken antibiotics for three weeks before the transplant
- Not have chronic (long-term) diarrhea, inflammatory bowel disease, or colorectal cancer
- Not be engaging in sexual behavior that has a high risk of sexually-transmitted disease
- Not be taking anti-cancer drugs
The donor will receive a prescription for 500 cc of normal saline to prepare the stool.
The evening before the FMT procedure, the donor will take a capful of the laxative Miralax in water at bedtime. The next morning, the donor will collect a fistful-sized amount of the stool in a “hat,” which can be obtained at any pharmacy.
In the hat:
- 500 cc of saline is added to the stool
- The stool is dissolved as much as possible with chopsticks or in a blender
- The mixture is filtered through a disposable coffee filter to eliminate particles
- The fluid is collected in a clean plastic container and refrigerated in a cooler while it is being taken to the endoscopy unit
- The stool mixture must be used within six hours of collection.
The recipient will be tested for the following:
- Hepatitis A, B, and C
- HIV 1 and 2
- HTLV 1 and 2
The recipient will be scheduled for a colonoscopy for the FMT procedure when he or she has been off antibiotics for one week.
The evening before the FMT procedure, the recipient will prepare his or her colon with a standard preparation for a colonoscopy. When the recipient arrives at the endoscopy unit, he or she will take two loperamide (Imodium) tablets (to slow digestion).
The FMT procedure
During the colonoscopy, up to 500 cc of the prepared stool fluid will be placed in the recipient’s right colon. The recipient should hold the stool as long as possible (at least two hours).
A driver must take the patient home.
Nutrition Services and Lifestyle Changes Regarding Digestive Disorders
Our Center for Human Nutrition is part of our Digestive Disease Institute. Nutrition plays a large role in treating the symptoms of having a digestive related disorder. Our Center is one of the only centers in the nation offering comprehensive services, including specialized teams for nutrition therapy, intestinal rehabilitation and nutrition support.
Treatment options and follow-up care may include working with our Center for Human Nutrition.
To see if you are a candidate for FMT, please contact the department of Gastroenterology and Hepatology.
Bret Lashner, MD