Dr. (Colonel) Avnish Seth
Head, Department of Gastroenterology & Hepatology at Manipal Hospital, Dwarka, New Delhi.
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Endoscopic Placement of Self Expanding Metal Stents in Bile Duct and Outlet of Stomach
Stool Transplant or Fecal Microbiota Transplant (FMT) is the term used to describe the ‘infusion of a fecal suspension from a healthy individual into the gastrointestinal tract of an individual with disease’. Eiseman and colleagues described the first published case of FMT in humans in 1958, when they reported the successful treatment of 4 patients with severe pseudomembranous colitis (PMC) using fecal enemas. At the time, the investigators were unaware they were treating Clostridium difficile infection (CDI) becausethe samewas not recognized as a cause of PMC until 1978. Fecal Microbiota Transplantation (FMT) is now an established indication for refractory Clostridium difficile infection (4). The Federal Drug Administration of US approved FMT for treatment of recurrent CDI in 2013.
Although the pathogenesis of ulcerative colitis (UC) is unclear, one hypothesis attributes the etiology and persistence of the inflammatory process to intestinal dysbiosis. In patients with UC, dysbiosis in UC has been consistently demonstrated with a decrease in Firmicutes and Bacteroides and an increase in Proteobacteria and Actinobacteria as compared to healthy population. Successful use of FMT for UC was first reported by Bennet in 1989 when he documented reversal of his own colitis following retention enemas from a healthy donor. Suffering from steroid dependent UC of 7 years he was asymptomatic without medication three months post FMT and colon biopsy revealed no active inflammation. In 2003, Borody et al from Sydney reported 6 patients with UC of less than 5 years duration, all of whom achieved drug-free remission 4 months following weekly FMT enema for 5 weeks. Four Randomized Control Trials on FMT for UC and a recent Systematic Review have shown significant response. Although no serious adverse events were reported, some patients experienced fever, chills, bloating, flatulence, vomiting, diarrhea, and abdominal tenderness. The adverse events were more likely with Nasogastric route of administration for FMT. Flares of UC following FMT were also described. We carried out the first successful FMT for UC in India on 14th November 2014 and the patient continues to do well on maintenance FMT without use of Corticosteroids or Azathiprine. We have successfully carried out Colonoscopic FMT in several patients from 7 states from India and 3 countries with a success rate of 60%. There have been no adverse effects.
FMT: Equipment required for processing donor stool at home
Sites of colonoscopic delivery of stool
Response of colitis to FMT
At 4 weeks
At 12 weeks
At 24 weeks
Stool ready for transplantation