Fecal Bacteriotherapy - Description of Procedure

Description of Procedure

The procedure involves single to multiple infusions (e.g. by enema) of bacterial fecal flora originating from a healthy donor. Most patients with CDI recover clinically and have the CDI eradicated after just one treatment. The procedure can be carried out via enema, through the colonoscope, or through a nasogastric or nasoduodenal tube. Although a close relative is often the easiest donor to obtain and have tested, there is no reason to expect this to affect the success of the procedure as genetic similarities or differences do not appear to play a role; indeed, in some situations a close relative may be an asymptomatic carrier of C.difficile, a disadvantage. Donors must be tested for a wide array of bacterial and parasitic infections. The fecal transplant material is then prepared and administered in a clinical environment to ensure that precautions are taken. The fecal microbiota infusions can be administered via various routes depending on suitability and ease, although enema infusion is perhaps the simplest. There does not appear to be any significant methodological difference in efficacy between the various routes. Repeat stool testing should be performed on patients to confirm eradication of CDI. In over 370 published reports there has been no reported infection transmission.

A modified form of fecal bacteriotherapy (Autologous Restoration of Gastrointestinal Flora - ARGF) that is easier to administer was being developed as of 2009. An autologous faecal sample, provided by the patient before medical treatment, is stored in a refrigerator. Should the patient subsequently develop C. difficile, the sample is extracted with saline and filtered. The filtrate is freeze-dried and the resulting solid enclosed in enteric-coated capsules. Administration of the capsules will restore the patient's original colonic flora and combat C. difficile.