Fecal Microbiota Transplantation (FMT)

We are pleased to offer fecal microbiota transplantation (FMT) for refractory, relapsing or severe cases of Clostridium difficile. This treatment will be performed by colonoscopy at Missouri Baptist Medical Center and will be available for outpatients and inpatients. Colonoscopy FMT has advantages over enema FMT including improved efficacy and simultaneous colon cancer screening.

FMT

A review of 536 FMT patients showed an overall cure rate of 87%. The cure rate varied according to the site of infusion: stomach 81%, duodenum 86%, enema 84%, and colonoscopy 93%.

In addition patients with severe and complicated disease have had safe and effective therapy: in one study 13 patients had a primary cure rate of 84% with one session and a secondary cure rate of 91% with a second session.

We would be happy to see you in our office to explain the risks and benefits of FMT.

Fecal Microbiota Transplantation (FMT) Forms:

PowerPoint Presentation:

What is Clostridium Difficile?
Clostridium difficile (also known as C. difficile or C. diff) is a bacterial organism that can cause diarrhea and life-threatening inflammation of the colon. It can affect people of all ages but most often infects older adults in hospitals, healthcare facilities and nursing homes. More and more we are seeing this as a community acquired infection at any age.

Symptoms of C. Diff
Symptoms of C. diff can range from mild to severe watery diarrhea. Below are the common symptoms associated with a c. diff infection.

Mild Disease Symptoms
• Watery diarrhea 3+ times a day
• Mild abdominal cramping

Severe and Life-Threatening Disease Symptoms
• Watery diarrhea 10+ times a day
• Nausea
• Weight loss
• Kidney failure
• Abdominal pain
• Bleeding (rare)

Risk Factors
• Broad-spectrum antibiotics
• Long-term use of antibiotics
• Exposure to people with C. difficile
• Use of proton pump inhibitors (Prilosec, etc.)
• Inflammatory bowel disease
• Colorectal cancer
• Kidney disease (dialysis patients often are infected)
• Surgery of the GI tract
• Chemotherapy or other immune deficiency conditions
• 65 years of age or older
• Previous C. diff infection

Complications
Complications from C. diff infections can be mild to severe and can include dehydration, kidney failure, toxic megacolon, and perforation (a hole in the large intestine) and death due to multi-organ failure.

Diagnosis and Treatment
C. diff is diagnosed by a physician and/or gastroenterologist based on the medical history, stool testing, and colon examination and imaging testing.

General Approach to Treatment
The first step in treating C. diff is with one of 3 specific oral antibiotics. Antibiotics treat mild to moderate C. diff. For severe cases of C. diff, doctors suggest intravenous and/or antibiotic therapy by enema. Fecal microbiota transplant (FMT) (also known as fecal transplantation) is a new approach at MO Bap for relapsing cases or severe cases of C. diff.

Web Content Continued
http://www.missouribaptist.org/Home/DigestiveDiseases.aspx /fecal-matter-transplant

Clostridium difficile infections have nearly doubled over the past 15 years – currently there are 700,000 cases per year. We are now seeing 50% of cases where antibiotics have not been identified as triggering the infection – this means the patient picked the infection up by touching and then swallowing C. diff spores in public bathrooms or in hospital and nursing home rooms. Up to twenty percent of patients have relapsing symptoms or fail antibiotic therapy. Fortunately, there is a highly successful treatment for patients, which involves something many people would never have thought could work (or imagined having it done to them). Fecal microbiota transplant (FMT) resolves the infection in roughly 90% of all patients. See the FAQs below and a patient testimonial. Call us for more information at 314-996-4627.

What is Fecal Microbiota Transplant?
Fecal microbiota transplant also known as fecal transplantation or stool transplant is a medical procedure where stool is collected from a healthy tested donor, strained and then transferred into a patient suffering from C. difficile infection. Fecal microbiota transplant is performed for patients with recurrent or severe C. diff. infections when antibiotic therapy has failed.

How Does a Fecal Matter Transplant Work?
Bacteria and other microorganisms are always present in the GI tract and many are necessary to maintain good health (we have 100 trillion bacteria in our intestines). Antibiotics can disrupt the balance in the GI tract and allow infectious bacteria like C. diff to take over. A fecal microbiota transplant involves placing good bacteria back into the colon to stop the overgrowth of C. diff. This “bacterial broth” is basically an immense probiotic treatment.

How is a Fecal Matter Transplant Performed?
A gastroenterologist transfers healthy donor stool and saline into the colon the patient during a colonoscopy. At MO Bap our gastroenterologists prefer performing FMT during a colonoscopy, which appears to have a higher success rate than other methods (enema, nasogastric tube or upper endoscopy). During the procedure, you will be given an IV with a sedative to make you relax and fall asleep. You should not feel anything during the procedure. This is performed most often in outpatients but inpatients are candidates as well. We use a highly screened fecal preparation from OpenBiome.

Is a Fecal Matter Transplant Safe?
Currently there are no documented cases of infection transmitted through a fecal transplant procedure. Donors are extensively screened and tested to be sure there are no signs of infection in the blood or stool. Donors are not allowed to have gastrointestinal diseases, autoimmune diseases, or the metabolic syndrome that might allow the patient to acquire a disorder caused by an interaction of the bacteria and the patient’s cells.

Risks of developing autoimmune diseases may be reduced when your donor is a relative. While all donors are screened to make sure they are healthy and carry no diseases, an unrelated donor may have bacteria that do not interact well with your own genetics. If possible, a donor who is a parent or child works best.

What is the Success Rate of a Fecal Matter Transplant?
Fecal microbiota transplant has a 93-84% success rate treating recurrent C. diff infection in patients in the United States. A recent study showed patients who had am FMT via a colonoscopy experienced a 93% success rate, compared to nasal tube or enemas, which were only 86% and 84% respectively. Only colonoscopy transfer is approved at MO Bap.

How long until I get better?
Generally, patients feel better within two days.

Clinical Trials Demonstrate High Success Rates
The Journal of Clinical Gastroenterology conducted a study of 77 patients who had a colonoscopy FMT for recurrent C. diff infections. The average symptom duration before FMT was 11 months, and patients had failed an average of five conventional antimicrobial regimens. The study concluded 74% of patients had a resolution of their diarrhea in less than three days. Diarrhea was resolved in 82% and improved in 17% of patients within an average of five days after the transplant. The primary cure rate was 91%. For patients who needed a second FMT, the success rate was 98%.

Administration of Fecal Microbiota Transplant: Colonoscopy Success Rates

In the above study, authors preferred colonoscopies as the method of fecal microbiota transplant for a number of reasons:

  1. Colonoscopy is considered to offer the advantage of recolonizing the entire colon with favorable bacteria;
  2. With colonoscopy, bowel cleaning is essential, which could help with the restoration of the colonic healthy microbiota by FMT, reducing the number of residual C. diff organization and spores;
  3. It allows the visualization of the entire colon, which helps rule out other diseases, such as inflammatory bowel diseases.

While a comparison of different delivery methods has not been performed, a review article of over 500 patients suggests that FMTs delivered by colonoscopy have the best success rate: 93% compared to 81-86% by other methods.


Patient Stories on FMT and C. difficile

I am writing to thank you and Trisha Meyers for accepting me as your patient on September 28, 2015.  I had been under the care of my previous gastroenterologist from July 21, 2015 for antibiotics associated with diarrhea caused by Clostridium difficile.  My test at Mercy hospital was positive for C-Diff on July 22, 2015. From that date, I was put on a regimen of Metrodonizole, but I became very ill and could not take the full dose.  My prescription was changed to Vancomycin on August 1, 2015.  This treatment did not work for me.  A few days after treatment ended the C-diff would return.  By mid-September, my previous doctor felt like I would have to take Vancomycin 4x daily for 4 weeks and then gradually reduce meds over a period ending in December since my test for C-Diff on September 18, 2015 was positive. When I came to your office, after consulting with you and Trisha Meyers, your opinion was that this treatment would only have a 10 percent chance of effectiveness due to my past history.  A Fecal Microbiota Transplant (FMT) was recommended, and after serious consideration, I agreed to it.  It was administered by Dr. Weinstock at Missouri Baptist Hospital on October 13, 2015, along with a colonoscopy.  It has now been one year since I contacted C-Diff, and I have had no recurrence.  The recovery was almost immediate and no side effects have occurred.  I wish to thank you, Dr. Weinstock, for your guidance through this episode.  I had been very ill and isolated from my family and friends during this period of four months, due to the contagious nature of the illness, and I lost a significant amount of weight and had very little appetite.  After the transplant, I have been able to return to a normal life again, and I just celebrated my 72nd birthday.  Thank you and Trisha once again for all of your help. J.A.

 


 

In August of 2014, I had a bad case of diarrhea, which did not go away, no matter what I tried.  I made an appointment with my Primary Doctor, and after two treatments of antibiotics the visit with "dear John" was not going away either. This was bad news for someone who is undergoing prostate cancer treatment as well. I did research on my own and found SIG clinic who specializes in such issues. Made an appointment, and all options were explained by Doctor Weinstock. In the end I chose the fecal transplant procedure, my wife being the donor. Home preparation was necessary before the transplant itself. The actual procedure was a quick, same day, and at home again. In about 36 hours the diarrhea was gone! Just like coming back from hell! I never felt so good, I had returned too normal as can be, in a short time.  Thanks to the specialist at SIG!

 


 

Misery after an abscessed tooth
"Little did I know that taking Clindamycin for my abscessed tooth would make me so sick. I experienced roughly 6 weeks of stomach discomfort, including watery diarrhea, nausea, light headed and just overall ill feeling. At first I thought it was a stomach virus that would pass. I then began to think I was gluten intolerant, yeast intolerant...I eventually went to my primary physician. Under the care of my primary physician over the next 3 months I was treated for suspected c. diff and was given multiple Rx for Metronidazole antibiotic even though my lab tests always came back negative for c diff.

I ended up in the hospital emergency room with finally a confirmed case of c diff and that is where I was referred to Dr. Weinstocks office. Which was a life saver!! Dr. Weinstock mentioned the FMT procedure initially. I was a little apprehensive and I thought the different antibiotics may do the trick. I was prescribed vancomycin, which I had symptom relief while on antibiotics, but as soon as I would end Rx symptoms would return within a few days. I tried vancomycin taper. I tried Dificid treatment. Each time I would feel improvement for short time, but symptoms would eventually return. I had trouble finding a specimen donor for FMT so I continued with antibiotic treatments hoping for a better outcome each time.

I finally had the FMT procedure and felt better almost immediately after procedure. I am over 8 months post FMT and I have returned to normal activities without C. diff symptoms. I still have stomach sensitivity. I think because of the havoc my colon endured for so many months. In retrospect I wish I would have had the FMT procedure immediately when diagnosed with C Diff."


Unromantic symptoms get unconventional treatment
Valentine's Day was anything but romantic for Victoria.* She had been suffering from Crohn's disease for a decade already. On Feb. 14, her symptoms became suddenly worse. "I couldn't leave the bathroom," she admits.

They tried a variety of antibiotics for a few months. “They would work for a little bit, then they wouldn’t work anymore, and it was right back to square one. I’d finally feel better, go back to work, and then the symptoms would start again.”

Dr. Weinstock told Victoria about a new treatment option, a fecal transplant. “I thought it sounded gross,” said Victoria. “But I would have done anything by that point. I’d had enough.”

In July, Victoria was the first MO Bap patient. She said, “I was so relieved; I didn’t want to go anywhere else. I wanted to do it at MO Bap.”

Victoria’s 30-year-old daughter agreed to be the donor. “She wanted to make me feel better so bad, and she did,” says Victoria. “I’ve been in remission, and I’ve had no problems since. I was at the mall just a couple days later. I couldn’t do that before. And I’m back at work.”

Victoria missed weeks of work because of her c-diff. “It’s embarrassing to explain why I had to miss so much work, but after my transplant, I finally told my boss what was going on. She had heard of c-diff, but she had never heard of fecal transplants.”

“There’s a great need for this procedure,” says Dr. Weinstock. “C-diff is a terrible disease and can be fatal. This quick procedure is life-changing and life-saving. I have had 8 patients who had to go out of state to get this treatment and they all got better.”

Read the full article/story on http://www.bjctodayonline.org/

 


"After having suffered for a year of constant diarrhea with C.dif, Dr. Weinstock performed a fecal microbial transplant on me. At first the procedure sounded distasteful to me but truthfully the standard prep for colonoscopy was the worst part. There was no pain or discomfort. I was anesthetized, kept comfortable and following the procedure laid in a slightly tilted position, head down for two hours. Went home and diarrhea stopped almost immediately and has not recurred. C.dif also disappeared. I feel great. Thank you Dr. Weinstock."


Keywords: FMT, fecal, transplant