Faecal Microbiota Transplant.

Imagine you are suffering from a stomach upset every two days, or that you’re lactose intolerant and every time you drink milk or consume dairy products you have to run to the bathroom as soon as possible. This is just one of the many situations.

The human body contains trillions of bacterial cells, more than human cells in or on the external surface of the body. These organisms may be symbiotic, commensals and/or pathogens. Some organisms may be symbiotic which when opportunity provides turn into pathogens. Out of the trillion cells, intestinal organisms are more and diverse than any other group of organisms present in the body.

Faecal Microbiota Transplantation:

Faecal microbiota transplantation is the transplantation of stool through the upper gastrointestinal tract. The stool is taken from a healthy donor and transferred to a recipient whose suffering from a disease that is related to an unhealthy gut microbiome. 

FMT was first described in 1958. The first use of FMT in western medicine was published in 1958 by Ben Eiseman and colleagues, a team of surgeons from Colorado, who treated people with using faecal enemas, which resulted in a rapid return to health. FMT is delivered through an enteral route through an endoscope, a nasoenteric tube or via capsules.

The mechanism is due to the concept of establishing a new gut microbiota community to restore the normal gut flora. It is based on repopulating the microbiome flora. 

FMT is used to treat  Clostridium difficile infection (CDI), inflammatory bowel disease (IBD), autoimmune disorders, allergic diseases and may also be used to treat metabolic disorders like obesity.

The faecal material is collected from the donor after screening. the donor collects their stools in a plastic bag. The stool is then diluted with saline and filtered through sterile gauze. The capsules can be made by dilution, blended and then pipetted in the capsule and then sealed by another capsule. Capsules can be used for up to 6 months and should be stored at -80 degree C.

Requirement for donor and recipient are:

Who is a recipient?

  • should have episodes of mild to moderate infection that has not responded to treatment with antibiotics
  • have episodes of severe infection, that needs admission
  • severe infection that did not respond to antibiotics within 2 days
  • Should not have any immunosuppressive disorders, cirrhosis of the liver or be on immunosuppressive drugs

Donor SHOULD NOT

  • have had any antibiotics in the last 3 months
  • be immunocompromised
  • have any tattooing or body piercing in the last 6 months
  • have a history of drug abuse
  • have a history of high-risk sexual behaviour
  • have a history of any incarceration
  • have travelled to endemic areas
  • have any other gastrointestinal disorder such as IBD

FMT can be transferred through the upper gastrointestinal tract. However, the delivery through this route results in an increased risk of vomiting etc. Hence, delivery by capsules seems a more reasonable choice. The capsule delivery reduces the procedure time, cost and risk of complications. 

Common side effects of this procedure include bloating and loose stools. FMT is considered a success if the recipient shows no signs of the earlier disease and doesn’t relapse for eight weeks. To ensure proper treatment, some patients require many sittings.

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