Fecal microbiota transplantation: donor relation, fresh or frozen, delivery methods, cost-effectiveness

Ramai, Daryl; Zakhia, Karl; Ofosu, Andrew; Ofori, Emmanuel; Reddy, Madhavi

doi:10.20524/aog.2018.0328

Cited by 56 publications

(86 citation statements)

References 97 publications

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“…Similarly, protocols using fresh versus frozen preparations also had no significant difference in terms of overall success rate. These results are consistent with recently published randomized control trials which reported similar findings . We recommend that institutions continue to use what is most convenient and accessible until further protocol standardization is possible.…”

Section: Discussionsupporting

confidence: 91%

Proton pump inhibitor in upper gastrointestinal fecal microbiota transplant: A systematic review and analysis

Hong

et al. 2020

J of Gastro and Hepatol

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Background and Aims Fecal microbiota transplantation (FMT) is used in recurrent Clostridioides difficile infections. However, protocols are facility dependent, and one variable is whether pre‐procedural proton pump inhibitors (PPIs) are given. In theory, PPIs reduce acidity and protect the transplanted microbiome for the most potent dose. We conducted a systematic review to study the effect of PPIs on FMT delivered by upper gastrointestinal (GI) routes. Methods We searched Pubmed/Medline, Cochrane Library, Embase, Scopus, and Web of Science through December 16, 2018 using variations of keywords “fecal microbiota transplant” and “Clostridium difficile infection.” Two authors independently reviewed 4210 results and found 11 qualifying studies with data on upper GI FMT, use of PPIs, and the rate of treatment failure at follow‐up. Results Of 233 included patients, treatment failure occurred in 20.6% of those with use of PPIs versus 22.6% in the group without (relative risk 0.91; confidence interval 0.56–1.50). Limitations include the lack of studies directly comparing outcomes based on use of PPIs and inability to control for possible confounders such as chronic PPI use, amount of stool transplanted, and pre‐FMT antibiotics. Conclusions We did not find evidence supporting a clinically significant benefit from routine use of PPIs in FMT protocol. It is possible that the theoretical benefit from improved survival of transplanted microbiota is offset by negative effects on the microbiome. We suggest that routine use of PPIs in upper GI FMT be reconsidered. Further investigation is needed to optimize protocols for safety and efficacy.

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Section: Discussionsupporting

confidence: 91%

Proton pump inhibitor in upper gastrointestinal fecal microbiota transplant: A systematic review and analysis

Hong

et al. 2020

J of Gastro and Hepatol

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“…It is not clear whether fresh or frozen-thawed microbiota improves the efficiency of FMT; however, frozen-thawed microbiota is a more convenient method (36,37). Hamilton et al (38) reported the successful use of standardized, partially purified and frozen fecal microbiota to treat C. difficile infection.…”

Section: Discussionmentioning

confidence: 99%

“…The therapeutic role of FMT in UC varies in different reports, as evidenced by the rate of clinical response ranging between 39 and 55% in four RCTs investigating the use of FMT in UC (55). Ramai et al (36) reported that the clinical response in patients at 1 month and 3 months after FMT was 74.3 and 51.4%, respectively. A pilot study in India reported 87.1% clinical response, 58.1% endoscopic remission and 45.2% histological remission at week 48 post-FMT (29).…”

Section: Discussionmentioning

confidence: 99%

Fecal microbiota transplantation ameliorates active ulcerative colitis

Chen

Huang

et al. 2020

Exp Ther Med

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Ulcerative colitis (UC) is a complex chronic pathological condition of the gut in which microbiota targeted treatment, such as fecal microbiota transplantation (FMT), has shown an encouraging effect. The aim of the present study was to investigate the efficacy and safety of FMT in patients with mild or moderate UC. A single-center, open-label study was designed, including 47 patients with mild or moderate active UC who received three treatments of fresh FMT via colonic transendoscopic enteral tubing within 1 week. The inflammatory bowel disease questionnaire, partial Mayo scores, colonoscopy, erythrocyte sedimentation rate, C-reactive protein level and procalcitoin values were used to assess the efficacy of FMT and alteration in gut microbiota was detected by 16S ribosomal RNA-sequencing. Before FMT, microbiota Faecalibacterium prausnitzii (F. prausnitzii) levels were significantly decreased in patients with UC compared with healthy donors (P<0.01). At 4 weeks post-FMT, F. prausnitzii levels were significantly increased (P<0.05), and the Mayo score was significantly decreased (1.91±1.07 at baseline vs. 4.02±1.47 at week 4; P<0.001) in patients with UC compared with healthy donors. Steroid-free clinical responses were reported in 37 patients (84.1%), and steroid-free clinical remission was achieved in 31 patients (70.5%) at week 4 post-FMT, however, steroid-free remission was not achieved in any patient. No adverse events were reported in 41 (93.2%) patients after FMT or during the 12-week follow-up. Shannon's diversity index and Chao1 estimator were also improved in patients with UC receiving FMT. In conclusion, the results of the present study suggested that FMT resulted in clinical remission in patients with mild to moderate UC, and that the remission may be associated with significant alterations to the intestinal microbiota of patients with UC. Furthermore, F. prausnitzii may serve as a diagnostic and therapeutic biomarker for the use of FMT in UC.

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“…Overall, FMT has the potential for enormous positive public health impact, preventing tens of thousands of CDI episodes every year. The FDA's policy of enforcement discretion, permitting the use of FMT to treat multiply recurrent CDI without an Investigational New Drug application, has enabled widespread use of this therapy (15). Stool banks have also played a key role in expanding safe access to FMT material that can be consistently screened in accordance with international guidelines (10).…”

Section: Discussionmentioning

confidence: 99%