What is a faecal microbiota transplant (FMT)?
A faecal microbiota transplant (FMT), or a gut microbiome transplant (GMT), is a medical treatment in which faecal matter from a healthy donor is processed and administered into a patient's gastrointestinal tract.
The primary purpose of FMT is to stabilise the microbiome by reintroducing beneficial microbes. In other words, FMT involves transferring the entire gut ecosystem from a thoroughly vetted donor to a patient to restore balance and cure disease.
How it works
FMT seeks to re-establish the physiological microbial equilibrium in the gastrointestinal tract, thereby modulating the gut environment and potentially influencing a patient’s metabolism, immune response, and gut barrier function.
Donor faecal material is meticulously screened and processed. It can be administered via multiple routes such as colonoscopy, nasogastric tube, oral capsules, or an enema, each with distinct advantages and clinical considerations.
Why do you need a faecal microbiota transplant (FMT)?
The most common disease that can be treated with FMT is recurrent, severe Clostridioides difficile (C. diff) infection. Many people have C. diff bacterium as a natural part of their gut microbiome but have no issues with it because of good bacteria that keep the C. diff bacteria in check.
However, when some people receive long-term antibiotic treatment, it can disrupt gut flora by eradicating the good bacteria along with the bad in their gut microbiome, causing the C. diff bacteria present to cause an infection that, in severe cases, can lead to watery diarrhoea 10 – 15 times daily, severe dehydration, a swollen belly, fever, nausea and more, making it life-threatening.
However, the therapeutic applications of FMT are broadening, with ongoing research investigating its efficacy in various other conditions, such as:
Who should not undergo a faecal microbiota transplant (FMT)?
People might not be able to get an FMT if their immune system isn’t strong, if they have heart conditions that aren’t stable, or if they’re experiencing intense bleeding in their digestive system.
Additionally, there are some patients who may be considered high-risk for adverse events. These include patients with IBD, ulcerative colitis (UC), Crohn’s disease, recipients of recent organ transplants, and other immunocompromised patients.
In these cases, it is advisable to seek a clinician’s opinion.
What are the risks and complications of a faecal microbiota transplant (FMT)?
It is generally considered a safe procedure for most people, but like any medical procedure, it carries certain risks and potential complications.
If you are receiving FMT through a colonoscopy, some temporary side effects might include:
- Swelling and gas in the abdomen
- Pain from air getting stuck in the large intestine during the treatment
- Bowel irregularity as a result of medicine to prevent diarrhoea
- Slight escape of the transplant fluid from the rectum* Common hazards from a colonoscopy, which include contamination, haemorrhage, a rupture or hole necessitating surgical intervention, and dangers associated with the use of anaesthesia
Other risks of FMT include:
- Infection. Although the stool used in FMT is thoroughly tested, there's a slight risk of transmitting infections from the donor to the recipient.
- Unexpected body responses. Rarely, individuals might experience unexpected changes in their body due to the new gut bacteria, like alterations in immune system response or metabolism.
- Long-term risks. The long-term risks of FMT aren’t fully understood yet. Changes in the gut bacteria could potentially impact various aspects of health over time, which researchers are still studying.