Discover more from Verified by Metafact
Does faecal microbiota transplantation work?
Faecal microbiota transplantation (FMT) is a medical intervention in which a patient is given faecal matter from a donor. It doesn’t sound pleasant, but does FMT work as a treatment against chronic gut infections? We asked 12 experts in microbiome and gastroenterology, “Does faecal microbiota transplantation work?”, all 12 said ‘yes’. Here is what we found…
Does faecal microbiota transplantation work?
What is faecal microbiome transplantation?
Each of us carry around 10-100 trillion microbes in our bodies, mostly in our guts. Most of these microbes are helpful whilst a few are harmful, and collectively they make up a complicated ecosystem called the ‘microbiome’. The balance of species in the microbiome are crucial to maintain our immunity and health, so some chronic diseases occur when the microbiome becomes imbalanced.
Dr Romy Zwittink, an expert in the microbiome from Leiden University in the Netherlands, explains that “Faecal microbiota transplantation is a very rigorous way of modulating the microbial communities in the gut (gut microbiota). The procedure consists of the introduction of diluted, filtered stool from a healthy donor into a patient's bowel via a duodenal tube, colonoscopy, enema, or via capsules.”
Exactly how the donor’s filtered stool can help certain conditions in patients is still unclear. It may be by restoring balance to the patient’s microbiome or by introducing microbes that outcompete the harmful ones in the patient’s gut. Dr Zwittink says “The mechanism of action is complex and appears to be based on direct interaction of metabolites and bacteriocins in the transplanted material and, as well as on the restoration of microbiota function via acquiring the healthy donor microbiota”
What is the evidence that FMT works?
FMT is not new, it was first described 1700 years ago by an ancient Chinese researcher. More recently, the effectiveness of FMT at curing different diseases has been studied extensively. Dr Kate Secombe, an expert in the microbiome from Adelaide University in Australia, says “There are over 1000 published papers in the area in the past 5 years! There have been varying results in this research, with FMT having positive results in some conditions, and less success in other areas. More research may be required to determine ideal treatment schedules and FMT preparation methods.”
FMT is routinely used to treat infection of a bacteria called C. diff. Infection of C. diff causes diarrhoea and can be fatal if recurrent or left untreated. Dr Ian Beales, an expert in gastroenterology from Norfolk and Norwich University Hospital in the UK, says “For recurrent Clostroides difficile infection (rCDI) Faceal microbiota transplantation is very effective and very safe. So much so that it is clearly the treatment of choice. Approximately 90% of patients with rCDI can be cured with FMT, results with antibiotics instead are much less satisfactory, only about 30% cure.”
Apart from for treatment of C. diff, FMT is still an experimental treatment. Dr Beales says “Promising results have been shown with positive results in ulcerative colitis and irritable bowel syndrome, although unlike the situation in rCDI, not all of the trials have given positive results”.
Why is FMT not used for more diseases?
Although many studies show promising results for FMT treatment of other diseases, they are not as clear-cut as those showing how well it works against C. diff. Dr Beales says “Certainly for ulcerative colitis, it seems that there are "super-donors," where the transplanted microbiota are effective, and other donors where the treatment is ineffective. In contrast in rCDI, it appears that transplantation from any suitably screened healthy donor is effective. At present, we do not know what makes anyone a 'super-donor.' ”
Dr Javier Santos, an expert in gastroenterology and the microbiome from Hospital Vall d’Hebron in Spain adds that “There are also many uncertainties regarding donor selection, faecal and recipient preparation, delivery methods and security issues that need to be solved before stepping ahead in generalizing FMT therapy.”
What is the future of FMT?
Despite these remaining hurdles, the future of FMT looks bright. Dr Hannah Wardill, an expert in the microbiome and cancer from Adelaide University says “I would not be surprised if in a 5-10years, there will be a much longer list of diseases where FMT is effective. I think we will also begin to see a lot more refinement in the approach, so it may actually be that FMT does not exist, but instead a poo capsule or more sophisticated probiotic formulation.”
FMT works against recurrent C. diff infection of the gut, it may also work against other diseases but more research needs to be done to confirm this.
May the facts be with you!
Do multivitamins make you healthier?
Exclusive reviews for our fact-loving members.
Each month we investigate a topic voted by the community by asking the world's top experts to review the evidence. Reviews are what you need to know. You can read all the reviews online here.
Chances are that you have some sort of supplement in your kitchen cupboards. Depending on the product that could be tablets, pills or even drops. There are a whole range of substances on offer as well, and they all promise to help our health in some way or another. Vitamin C supplements claim to protect our immune system. Vitamin D pills say they keep our bones strong. Collagen powder is there to keep your skin from sagging. Creatine is the bodybuilder’s new best friend. But do they all do as they claim?
This month we asked scientists and clinicians to share the facts on supplements*.* With vitamin supplements accounting for most of the supplements market, we will focus on them - but not only. Does vitamin C prevent colds? Do we need to take vitamin D pills to avoid bone fractures? Do those ‘anti-ageing’ products actually work? And do we need any supplements if we go vegan?
Here’s what we found…