The Science Behind FMT

The application of HMT has been extensively review in published scientific journals. Four selected articles are presented above, with additional articles presented below.


Treatment of Clostridium difficile infection


Fecal microbiota transplant in patients with Clostridium difficile

infection: A systematic review. J Trauma Acute Care Surg 2016, Vol 81(4):756-764.

RESULTS: Retrospective and uncontrolled prospective cohort studies suggest that FMT is a highly effective therapy for recurrent/refractory CDI, with clinical success rates ranging from 83% to 100%, which is similar to rates published by two randomized controlled trials.


Fecal Microbiota Transplantation for Clostridium difficile Infection

A Systematic Review.   Ann Intern Med. 2015;162:630-638.

RESULTS: Two randomized, controlled trials (RCTs); 28 case-series studies; and 5 case reports were included. Two RCTs and 21 case-series studies (516 patients receiving FMT) reported using FMT for patients with recurrent CDI. Across all studies for recurrent CDI, symptom resolution was seen in 85% of cases.


Treatment of Inflammatory Bowel Disease


Fecal Microbiota Transplantation as Therapy for Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. J Crohns Colitis. 2014 Dec 1; 8(12): 1569–1581.

Results: Eighteen studies (9 cohort studies, 8 case studies and 1 randomized controlled trial) were included in the analysis. 122 patients were described (79 ulcerative colitis (UC); 39 Crohn's disease (CD); 4 IBD unclassified). Overall, 45% (54/119) of patients achieved CR during follow up


Fecal Microbiota Transplantation is Safe and Efficacious for Recurrent or Refractory Clostridium difficile Infection in Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis. 2016 Oct;22(10):2402-9.

RESULTS: Sixty-seven patients were included in the analysis. Thirty-five (52%) had Crohn's disease, 31 (46%) ulcerative colitis, and one indeterminate colitis with 43 (64%) patients on an immunosuppressive agent at the time of FMT. The initial FMT was successful in 53 (79%) patients. After the FMT, IBD disease activity was reported as improved in 25 (37%), no change in 20 (30%), and worse in 9 (13%) patients. 


Treatment of Inflammatory Bowel Disease: Crohn's Disease


Fecal microbiota transplantation through mid-gut for refractory Crohn's disease: safety, feasibility, and efficacy trial results. J Gastroenterol Hepatol. 2015 Jan;30(1):51-8.

Results: Metagenomics analysis showed a high concordance between feces sample and purified fecal microbiota from same donors. Standardized fecal microbiota preparation and clinical flow significantly simplified the practical aspects of FMT. Totally, 30 patients were qualified for the present analysis. The rate of clinical improvement and remission based on clinical activity at the first month was 86.7% (26/30) and 76.7% (23/30), respectively, which was higher than other assessment points within 15-month follow-up. Patients' body weight increased after FMT, and the lipid profile improved as well. FMT also showed a fast and continuous significant effect in relieving the sustaining abdominal pain associated with sustaining CD.


Increased Intestinal Microbial Diversity Following Fecal Microbiota Transplant for Active Crohn's Disease. Inflammatory Bowel Diseases:2016 , 22 (9): 2182–2190.

Results: Nineteen subjects were treated with FMT and completed the study follow-up. Fifty-eight percent (11/19) demonstrated a clinical response (Harvey–Bradshaw Index decrease >3) following FMT. Fifteen subjects had sufficient pre/postfecal samples for analysis. A significant increase in microbial diversity occurred after FMT (P = 0.02). This was greater in clinical responders than nonresponders. Patients who experienced a clinical response demonstrated a significant shift in fecal microbial composition toward their donor's profile as assessed by the Bray–Curtis index at 4 weeks (P = 0.003). An increase in regulatory T cells (CD4+CD25+CD127lo) was also noted in recipients' lamina propria following FMT. No serious adverse events were noted over the 26-week study period.

Additional Published Papers:


Fecal microbiota transplantation: past, present and future.

Curr Opin Gastroenterol 2013, 29:79–84.


Fecal Microbiota Transplantation for Clostridium difficile Infection: Systematic Review and Meta-Analysis. Am J Gastroenterol 2013; 108:500–508.


Long-Term Follow-Up of Colonoscopic Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection. Am J Gastroenterol 2012; 107:1079–1087.


Fecal Microbiota Transplantation for Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2016 Jun;12(6):374-9.


Endoscopic Delivery of Fecal Biotherapy in Inflammatory Bowel Disease.

Gastrointestinal Endoscopy Clinics of North America, 2016,26(4):707-717


Fecal microbiota transplantation for gastrointestinal diseases. Keio J Med. 2014;63(4):69-74.


Systematic review: faecal microbiota transplantation in the management of inflammatory

bowel disease. Aliment Pharmacol Ther 2012; 36: 503–516.


Fecal microbiota transfer (FMT) in a patient with refractory irritable bowel syndrome.

Dtsch Med Wochenschr. 2015 Aug;140(16):1232-6.

Irritable bowel syndrome is a disorder of the gastrointestinal tract with unknown etiology. Recent clinical data support a link between changes in fecal microbiota with decreased biodiversity and the development of irritable bowel syndrome. Whether these changes of the microbiota are caused by the disease or whether they develop during the course of the disease remains unclear. Several studies demonstrated that fecal microbiota transfer (FMT) successfully attenuates Clostridium difficile infection by restoring the disturbed bacterial flora of the gut and case reports suggest that FMT may relief symptoms in patients with irritable bowel syndrome (IBS). Here we report a 47-year-old male patient with longstanding refractory diarrhea predominant IBS, who was successfully treated with a single FMT. The beneficial effect on the patient's symptoms was associated with changes of the stool microbiome. Post-FMT the recipient's microbiome resembled the donor's microbiome.


Fecal Microbial Transplant Effect on Clinical Outcomes and Fecal Microbiome in Active Crohn’s disease.  Inflamm Bowel Dis. 2015 Mar; 21(3): 556–563.


Faecal microbiota transplantation for recurring Clostridium difficile infection in a patient with Crohn's disease and ileorectal anastomosis. BMJ Case Rep. 2016 Sep 23;2016.


Pilot study on the safety and efficacy of faecal microbiota transplantation in refractory crohn’s disease. Gastroenterology 2012;142(5 Suppl 1):S360


Fecal Microbiota Transplantation as a Novel Therapy for Ulcerative Colitis: A Systematic Review and Meta-Analysis. Medicine (Baltimore). 2016 Jun; 95(23): e3765.


Multi donor intense fecal microbiota transplantation is an effective treatment for resistant ulcerative colitis: a randomized placebo-controlled trial. Gastroenterology 2016;150(4):S122–3.


Fecal microbiota transplantation induces remission in patients with active ulcerative colitis in a randomized controlled trial. Gastroenterology 2015;149(1):102–9.e6.


Step-up fecal microbiota transplantation strategy: a pilot study for steroid-dependent ulcerative colitis. J Transl Med. 2015 Sep 12;13:298.


Fecal microbial transplant via nasogastric tube for active pediatric ulcerative colitis.  J Pediatr Gastroenterol Nutr. 2015 Jan;60(1):27-9.


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