Fecal microbiota transplantation (FMT) involves transferring stool from a healthy donor into a patient to treat recurrent Clostridium difficile (C. diff) infection. FMT has been used in China since the 4th century and the FDA approved its use for C. diff in 2013. C. diff affects over 250,000 people annually in the US and causes diarrhea, dehydration, and even death. The FMT procedure introduces donor stool into the patient's GI tract via enema or capsules to reestablish healthy gut bacteria and clear the C. diff infection, with over 90% success rates reported. Candidates usually have multiple relapses of C. diff despite antibiotic treatment.

1. Fecal Microbiota
Transplantation
JOHN LITTLE, SPT
WHEELING JESUIT UNIVERSITY

2. History
▪ First documented in 4th Century China as “Yellow Soup”
▪ In some countries, maternal feces is inserted into the newborn’s
mouth to “jumpstart” the colon
▪ June 17th, 2013: FDA approved the procedure for recurrent C. diff.
▪ 0 documented serious side effects
▪ 92% - 95% success rate

3. Clostridium difficile (C. diff.)
▪ 250,000 hospitalizations and 14,000 deaths per year in the US
▪ A harmful bacteria that replaces the “good”, naturally occurring
bacteria in the digestive tract
▪ Can occur from several factors but most commonly from long term
antibiotics and hospital visits
▪ The bacteria can live on a surface for months and is transmitted
orally
▪ Symptoms include diarrhea (up to 10-15x per day), dehydration,
blood/pus in the stool, kidney failure, bowel rupture, and death
▪ 20% reoccurrence

4. The Procedure
▪ Carefully screened donor stool is mixed with a saline solution
▪ The solution is introduced into the GI tract via a NG tube, fecal
enema, oral capsules, or during a colonoscopy
▪ The “good” bacteria multiply and help flush out the C. diff. bacteria
▪ 92% - 95% success rate

5. Are You a Candidate?
▪ General Requirements:
▪ Recurrent C. Diff. (usually 3 cases)
▪ 1 failed course of Vancomycin
▪ 2 or more severe cases, resulting in ICU admittance
▪ Where is this procedure performed?
▪ Clinicians offering this procedure that are located closest to Cabell
Huntington Hospital include:
▪ Columbus, Ohio
▪ Cleveland, Ohio
▪ Indianapolis, Illinois

6. Price of the Procedure
▪ Most insurance policies do not cover the procedure
▪ There is no fee for the actual procedure, if your insurance will cover
the colonoscopy
▪ Out of pocket costs for a colonoscopy are often $3,000
▪ Oral capsule administration is usually $500

7. References
Feltman, Rachel. "Good News: You Can Take Your Fecal Transplants
Orally." The Washington Post, 11 Oct. 2014. Web. 8 July 2015.
<http://www.washingtonpost.com/news/speaking-of-
science/wp/2014/10/11/good-news-you-can-take-your-fecal-
transplants-orally/>.
"The Fecal Transplant Foundation." 2015. Web. 8 July 2015.
<http://thefecaltransplantfoundation.org/>.