Transplantation of intestinal microflora

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What is a gut flora transplant?

A fecal flora transplant, also known as a flora or intestinal microbiota transfer (FMT – fecal microbiota transplant), is a treatment method that involves taking stool from a healthy person and inserting it into the intestine of a sick patient. Its performance is justified after prolonged antibiotic treatment or after a severe intestinal infection.

Transplantation of intestinal microbiota involves the transfer of microorganisms residing in a healthy donor’s intestine into a sick recipient’s digestive tract. Microbiota transplantation is performed to restore the natural composition of bacteria in the gut. It is currently recommended in the standards for the treatment of recurrent Clostridioides difficile (formerly Clostridium difficile) infections, where its efficacy is 92% when administered orally.

The intestinal microbiota is all the microorganisms that reside in the human gastrointestinal tract. These are primarily bacteria, viruses and fungi. The microbiota participates in processes related to digestion and absorption of nutrients, and the bacteria that make up the microbiota perform a variety of functions; their correct quantitative and qualitative structure determines the homeostasis of the entire body, shaping immunity, metabolism and synthesis of many chemical compounds. Hence the importance of its correct composition.

Fecal transplantation is also being carried out in cancer patients, as chemotherapy negatively affects the condition of the intestinal mucosa and compromises the body’s immunity. Research is also underway to use the therapy to treat obesity, metabolic syndrome, multiple sclerosis, Parkinson’s disease, chronic fatigue syndrome and autism.

In HiperMedica, intestinal microflora transplantation procedures are performed by Dr Aneta Bartczak and Dr Maciej Wysocki

The incidence of Clostridioides difficile infection (CDI), as well as the mortality associated with it, has increased significantly over recent years. This applies to both infections that occur in hospitals and outside medical facilities. In Poland, 21371 cases of CDI were reported in 2022, of which 71% of people were hospitalized.

CDI can occur in the form of various clinical syndromes: from mild post-antibiotic diarrhea, through pseudomembranous colitis, to fulminant colitis or toxic dilatation of the colon, so-called megacolon. CDI is a recurrent disease. Its recurrence is diagnosed on the basis of symptoms confirmed by fecal examination. Recurrence occurs 2-8 weeks after a previous episode, the symptoms of which have resolved with or without treatment.

In patients who experience a second relapse, vancomycin is used. Other therapeutic approaches are also possible in treatment regimens: treatment with fidaxomicin or transplantation of the intestinal microbiota. Transplantation of the intestinal microbiota is recommended for those who have had multiple recurrences, and previous antibiotic regimens used appropriately have proven ineffective. In transplantation procedures for C. difficile infection, Bioethics Committee approval is not required.

Other indications for FMT include:

– resistance to treatment of irritable bowel syndrome (IBS);

– resistance to treatment of small intestinal bacterial overgrowth syndrome (SIBO);

– colonization of the gastrointestinal tract with strains of antibiotic-resistant bacteria (so-called alert pathogens).

Bioethics Committee approval is required for these indications.

After diagnosis and health assessment, the patient can be qualified for antibiotic therapy and gut microbiota transplantation. Prior to the FMT procedure, a four-day treatment with vancomycin is usually applied, then the antibiotic is discontinued and bowel cleansing is performed with laxatives, usually osmotically active, to reduce the amount of C. difficile in the intestines.

The gut microbiota preparations used at HiperMedica come from the Human Biome Institute. The capsules contain microbiota from healthy donors who have undergone a series of screening tests, including a 100-point health questionnaire and more than 30 blood and stool tests. Donors are monitored and re-screened at fixed periods of time. The donor is always examined a minimum of two times before the material from the donor is made available for treatment. All this is done to make the material as safe and effective as possible at the same time.

After treatment, you can return to a normal, healthy diet, but you should avoid factors that can lead to a recurrence of the infection, primarily antibiotics. Thus, FMT should be communicated to the PCP so that if an antibiotic is needed, he or she will choose the preparation with the least risk of causing CDI.