‘It’ Happens: All About Fecal Transplants

Today we’re talking about poop. Feces, crap, stool, doodoo, turds, #2, bowel movement, sh*t. It’s got a million and one names yet it’s considered impolite to talk about it. Everyone does it and today we’re going to celebrate it. Poop. Specifically fecal transplants or fecal microbiota transplantation, FMT if you’re squeamish. The good, the bad, the how, and the why would you ever want to do that: this is one medical procedure we really want to talk about.

What is a fecal transplant?

Let’s start with the basics: a fecal transplant is a procedure that takes stool from a healthy person and introduces it into the gastrointestinal tract of someone who has a C. diff infection or another medical need. 

The good news is that it’s not as gross as it sounds.

The even better news is that it can be incredibly successful.

Why would you need a fecal transplant?

As we all know, your gut microbiome is home to trillions of bacteria, some good, some bad. When the bad bacteria begin to outnumber the good bacteria, or the diversity of the bacteria is low, you can develop intestinal problems. One such problem is caused by Clostridium difficile, or C. diff. This is a bacteria that can cause an infection of the large intestine ranging in severity from simple diarrhea to life-threatening. 

Patients with C. diff can take antibiotics, but of course antibiotics kill off the good bacteria as well as the bad. Because of this, about 20% of people who take antibiotics for C. diff develop the infection again, likely caused by the antibiotics disrupting the gut microbiome. In contrast, fecal transplants have a cure rate of 80% to 90%, meaning the vast majority of patients are cured with a single treatment. This is why fecal transplants have become the standard of care for recurrent C. diff infections.

How is a fecal transplant performed?

Again, the good news is it’s not as gross as you might think. The most common way a fecal transplant is performed is by colonoscopy. First, the donor stool sample is mixed with a saline solution. Then a gastroenterologist guides a flexible tube called a colonoscope through the entire length of the colon, and as the scope is removed, the liquid fecal transplant solution is deposited in the colon.
Sometimes the transplant is performed via a tube inserted through the nose and into the duodenum, but this procedure comes with higher risk and is less common.

After a fecal transplant, the patient usually returns home to rest. Often they are given anti-diarrheal medication to keep the fecal transplant in the colon so that it can get to work populating the microbiome with good bacteria.

The history of fecal transplants

If you’re wondering how long people have been conducting fecal transplants, you may be in for a surprise. The concept of fecal transplants was described approximately 1,700 years ago by a Chinese medical scientist who orally administered human fecal suspension to treat patients for food poisoning or severe diarrhea. Of course, this was risky, and today’s transplants are sterile and safe. 

One of the first case studies for modern fecal transplants was published in 1983. However, the practice didn’t gain traction until the medical world noted the rise of increasingly antibiotic-resistant strains of bacterium. Searching for new ways to treat patients with virulent infections, doctors turned to fecal transplants.

The future of fecal transplants

As the medical community learns more about the importance of the gut microbiome to overall health, it should come as no surprise that the application of fecal transplants continues to grow. Doctors have begun to test the efficacy of fecal transplants in people who have ulcerative colitis, Crohn’s disease, multiple sclerosis, Parkinson’s, depression, obesity, diabetes, and autism spectrum disorder

Increasingly, fecal transplants are sometimes referred to as microbiome transplants, removing any mention of fecal matter which may not market well to patients. But no matter what you call it, one thing’s for sure: poop will play an important role in the future of not only microbiome science, but overall health.

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