Fecal Microbiota Transplant

fecal-transplant

Please scroll down for DIY FMT Protocol

The human bowel contains a complex population of bacteria containing several hundred different species. The colon itself is densely populated with around 500 species and more than 30,000 subspecies of various normal bacteria. These organisms and the chemicals they produce affect the body and these effects can have both positive and negative impacts on health. The human flora protects us from pathogenic or “bad” bacteria, however if a bad bacterium does implant itself into the population of normal healthy “good” bacteria, it can have a debilitating and sometimes toxic affect on our health. Due to the nature of the bacteria which are able to produce spores, it is difficult to remove the infection which can remain for many years, even a lifetime.

The use of healthy human flora appears to be the most complete probiotic treatment available today. It acts as a broad-spectrum antibiotic capable of eradicating “bad” bacteria and spores, and supplies the “good” bacteria for recolonisation.

This therapy involves the infusion of healthy human donor faeces via enema into the bowel, which is prepared prior to the procedure. This infusion process is repeated for at least five days, depending on the severity of the condition.

Fecal Microbiota Transplant (FMT) is a procedure in which fecal matter, or stool, is collected from a healthy, tested donor, mixed with a saline or other solution and placed in a patient, usually by colonoscopy, endoscopy, sigmoidoscopy, or enema.

The purpose of fecal transplant is to repopulate the gut with good bacteria that has been killed or suppressed, usually by the use of antibiotics, causing an imbalance of bad bacteria over good.

Fecal transplant was first documented in 4th century China, known as “yellow soup”.
It has been used for over 100 years in veterinary medicine, and has been used regularly for decades in many countries as the first line of defense, or treatment of choice, for C. diff. It is customary in many areas of the world for a newborn infant to receive a tiny amount of the mother’s stool by mouth, thought to provide immediate population of good bacteria in the baby’s colon, thereby jump-starting the baby’s immune system.

Fecal transplant has been used in the U.S., sporadically since the 1950′s, without much regulation. It has gained popularity in the U.S. in the past few years, although experts estimate that total number of treatments to date in the U.S. remains below 500 patients.

In late spring of 2013, the FDA announced it was classifying fecal matter as both an Investigational New Drug (IND) and a Biologic, and that only physicians currently in possession of an approved IND application would be allowed to continue performing fecal transplant.

The procedure has proven to be incredibly successful for treating C. Diff (a potentially fatal bacterium infection of the colon) 90-98% success! Early reports have shown very promising potential for treating Ulcerative Colitis and Crohn’s disease, the problem tends to be how long it will be effective for before symptoms return. It appears that it can be effective for up to a year or only a couple of weeks. This may depend on the donor and their compatibility with the patient.

The procedure can be carried out in a clinic but it is often quite expensive so people often opt to do this at home. Other than it being a bit hard to stomach, the procedure itself is actually quite easy to carry out.

Here are some clinics around the world that perform the procedure

Australia

The Centre for Digestive Diseases, Sydney, NSW

Dr Sanjay Nandurkar, Box Hill, VIC

Moonee Valley Specialist Centre, Moonee Ponds, VIC

Melbourne FMT, Moonee Ponds, VIC

 

South America

The Newbery Clinic, Buenos Aires, ARGENTINA
(Skype consultations available in English)

Dr. Arnaldo Jose Ganc, San Paulo, Brazil

 

United Kingdom

C diff only unless indicated

Taymount Clinic, Hitchin, UNITED KINGDOM (all conditions)

Dr Simon Goldenberg, London, UK

Dr Benjamin Mullish, London, UK

Dr. Alisdair MacConnachie, Glasgow, UK

Dr Jeremy Sanderson, London, UK

Prof Peter Hawkey, Birmingham, UK

The Somerset FMT Clinic, near Bristol, UK (all conditions)

 

Europe

C diff only unless indicated

Dr Gero Moog, Kassel, GERMANY

Prof. Dr. med. Martin Storr, Gauting Starnberg GERMANY

Prof. Dr. Christoph Högenauer, Auenbruggerplatz AUSTRIA

Dr Josbert Keller, Haga Teaching Hospital, The Hague, NETHERLANDS

Prof. Gerhard Rogler, University Hospital, Zurich, SWITZERLAND

Ryhov Hospital Jönköping, SWEDEN

Q Living Klinik, København DENMARK

Dr. Eero Mattila & Dr Martti Frakkila, Helsinki University Central Hospital, FINLAND

 

Asia

Dr Ajit Sood, Dayanand Medical College & Hospital, Ludhiana, Punjab, 141001, INDIA

 

USA & CANADA –   C DIFF ONLY *

 

* US & Canadian doctors are only permitted to do FMT for patients with C diff that does not respond to multiple courses of antibiotics.   They may be willing to test your donor for DIY FMT if you have another condition and advise on the procedure, however they are not obliged to do so.  If you do not have C diff doctors are not permitted to do the procedure for you. Please don’t ask them to do this as their hands are tied by legislation.

 

Canada *

Dr Christine Lee Hamilton Hospital in Hamilton, Ontario

Thomas Louie, MD, University of Calgary

Dr. David Kreaden, Toronto, Canada

 

USA *

Joseph Brasco MD, Huntsville, AL

Mayo Clinic in Phoenix AZ 

Andrew Weinberg MD, Gilbert AZ

Purety Family Medical Clinic, Santa Barbara, CA

Shelley Gordon MD, California Pacific Medical CA

Alister George MD, Thousand Oaks, CA 

Neil Stollman MD, Oakland, CA  (C. diff only. Doen’t help with DIY)

Allen Kamrava MD, Beverly Hills, CA

Los Angeles Colon and Rectal Surgical Associates CA

KT Park MD, Palo Alto, CA (pediatrics)

Steve Freeman, MD, University of Colorado

Jose Vasquez, MD, Brandon, FL

Lawrence Fielder MD, Boca Raton, FL

Sovi Joseph, Port Charlotte, FL

Katherine A. Kosche, MD, Pembroke Pines, FL

RDS Infusions, Tampa FL (David Shepard MD)

Tanvi Dhere, MD, Johns Ck, GA

Jeffrey D. Lewis, MD, GA — (pediatrics)

Satish M Rao, M.D. Augusta, GA

Douglas Wolf St.Joseph, Atlanta GA

Eugene F Yen MD , Evanston, IL

David Rubin, MD, Chicago IL

Prabhakar Swaroop, M.D Chicago IL

Arnab Ray MD, New Orleans, LA

Brian Gill MD, Plymouth, MA .

Maria Oliva-Hemker, M.D. John Hopkins Children’s Hospital Baltimore, MD

Maria Oliva-Hemka MD, Baltimore MD  (Paediatrician)

Sudhir K. Dutta MD, Baltimore MD

Michael J. Docktor, Boston MD (IBD Pediatrician)

Tim Rubin MD, Minnesota

Mayo Clinic Minnesota

Alexander Khoruts MD, Minneapolis MN

Darrell Pardi, MD / Sahil Khanna, MMS Mayo Clinic, Rochester, MN

Jack Bragg and Dr. Ghassan Hammoud, University of Missouri Health Center, Columbia, MO

William M. Chamberlin, MD, Billings MT

Martin H Poleski, MD, CM Durham, NC 

Robert T Elliot MD, Burlington, NC

Barry Schneider MD, Charlotte, NC

Susan Edwards DHMC LebanonNH  (pediatrics)

Robert W. Schuman MD, West Orange, NJ

Kevin S. Skole, MD, Plainsboro, NJ

Daniel Hamptom, MD, Las Cruces, NM

Daniel Hampton MD, Las Cruces, NM, USA

Gastroenterology Consultants, Reno, NV

Ellen Scherl, MD, NY NY .

Caterina Oneto, MD, NYU School of Medicine

Lawrence Brandt, New York, NY

Lee Ann Chen MD, NY, NY

Caterina Oneto, MD, NY, NY

Jonathan Goldstein MD, Rochester, NY

Lisa B Malter, NY NY

Microbiomes LLC, Portland, OR (Carmen Campbell ND & Mark Davis ND)

Paul F Schleinitz MD, Oregon

Alka Goyal, MD, Pittsburgh, PA  (pediatrician)

Jackson Seigelbaum, MD, Gastroenterology Harrisburg, PA

Drexel Medicine, Philadelphia, PA & other locations

Colleen Kelly MD. Rhode Island

Gordon France, Spartanburg Regional, SC

Joseph Baber DO FACP, Greenville, SC

Michael Vaezi, MD, Nashville, TN

Mahdi M. Budayr, MD, Maryville, TN

Dr. Sara Horst and Dr. Dawn Beaulieu through Vanderbilt IBD Clinic, Nashville, TN

Maribeth Nicholson, MD Nashville, TN (pediatrics)

F. Lyone Hochman, MD, Houston, TX

Melvin K Lau MD and Dr Vu Nhu Nguyen MD, Round Rock, TX

John F. Pohl MD, Salt Lake City, UT  (Pediatrician)

David A Johnson MD, Norfolk, VA

Michael B Edmond MD, Richmond, VA 

David L Suskind MD, Seattle, WA (pediatrics)

Christina M Surawicz, MD Seattle, WA
 (pediatrics)

Roy Ozanne MD, Langley, WA

Gary Griglione, MD Madison, Wisconsin

Steven L Werlin, MD, Milwaukee, WI (pediatrician)

DIY FMT PROTOCOL

Here is the protocol for carrying out FMT at home. It is important to have a doctor on your side who is open to alternative treatments. The use of antibiotics is a part of this protocol but some people prefer to exclude them. It is extremely important to have your donor stool screened to ensure they do not have any parasites or unwanted issues which could cause further problems to the patient. Your doctor may be able  to arrange donor stool screening. If not there are usually labs locally who will do this.

These instruction suggest the use of an enema bag but an enema bottle can also be used.

There is also more information about fecal transplants and a different set of DIY instructions on The Power of Poop.com

Patient DIETARY REQUIREMENTS

You will need to go on a LOW FIBRE DIET at least TWO WEEKS before beginning the antibiotics and during the course of the antibiotics. The following list gives you an idea of low fibre foods:

¨       Refined cereals – white bread, pasta, rice cakes and pastries made from white flour

¨       Milk (all forms)

¨       Butter, margarine, oils

¨       Chicken and fish

¨       Egg dishes

¨       Jellies, custards, mousses

¨       Fruit and vegetables (cut down the amount you eat and discard the peel) – the following are relatively low in fibre:

Apples Pears Melon Peaches Cherries Plums Grapes
Pumpkin Zucchini Marrow Lettuce Capsicum Cucumber Potato

Foods to AVOID:

¨       Pork

¨       Processed meats: sausages, ham, salami

¨       Citrus Fruits

¨       Nuts and seeds

¨       Berries and dried fruit

Your diet must change to a HIGH FIBRE DIET after your first probiotic infusion and we recommend you maintain this high fibre diet to enable the new flora to be strong enough to survive and implant. You are able to eat the following:

¨       Anything “wholemeal” – bread, pasta, brown rice, pulses (lentils, beans, chickpeas), muesli, fibre enriched cereals.

¨       All fresh fruit and vegetables, including juices

¨       All meat, fish and chicken

AVOID the following foods:

¨       Oysters, shellfish, prawns

¨       Processed meats

EQUIPMENT FOR THE INFUSION

¨       Enema bags

¨       Rectal tips

¨       Bottles or bags of normal saline.

¨       Lubricant

¨       Latex gloves

¨       Psyllium husks

¨       Imodium tablets (Loperamide)

You will also need the following

¨       Somewhere to hang the enema bag from, ie nail in the wall.

¨       Funnel

¨       Tissues

¨       Stool collection device (disposable ‘takeaway’ container or a potty!)

¨       Blender

BOWEL PREPARATION

You need to purchase medication for a COLONIC LAVAGE. – Usually this is available from a chemist without prescription.  This is the same bowel prep you would use if you were undergoing  a colonoscopy.

SCHEDULE FOR PROBIOTIC INFUSION

ANTIBIOTICS

You will need to take one or two of the following antibiotics as per the schedule below for a minimum of 10 day.  You will be advised accordingly.

TIME RIFAMPICIN VANCOMYCIN FLAGYL
Morning 1 capsule (150mg) 2 capsules (250mg) 1 tablet (400mg)
Night 1 capsule (150mg) 2 capsules (250mg) 1 tablet (400mg)

 

Your last dose of antibiotics  will be taken       
the night before your bowel washout

Diet

You should still be maintaining your low fibre diet at this point. Please refer to diet requirements section.

Bowel wash out. ( day before the first probiotic infusion )

ENSURE YOU HAVE CEASED YOUR ANTIBIOTICS BY THIS DATE

On waking in the morning:

¨       DO NOT EAT any solid foods.

¨       DRINK CLEAR FLUIDS ONLY – eg. clear soups, clear fruit juices, tea, coffee , Bonox, soft drinks.

¨       Follow the instructions on the back of the packet of the colonic prep starting at 10 am approximately  (rather than the time mentioned on the packet).

¨       Drink the colonic prep throughout the day as per instructions on packet.

¨       IMPORTANT – please ensure you maintain your fluid intake to prevent dehydration..

COLONIC PREPARATIONS PROMOTE DIARRHOEA

Be prepared to visit the toilet regularly throughout the day

DAY ONE OF YOUR  PROBIOTIC INFUSION

In the morning, on rising, take 2 IMODIUM tablets.  You only take these on the first morning of the infusion.

Diet

You will need to start your high fibre diet today as per instructions.  You may have a light breakfast before commencing your daily infusions..

Infusion procedure

Fecal Microbiota Transplant (FMT) is a procedure in which fecal matter, or stool, is collected from a healthy, tested donor, mixed with a saline or other solution and placed in a patient, usually by colonoscopy, endoscopy, sigmoidoscopy, or enema.

The purpose of fecal transplant is to repopulate the gut with good bacteria that has been killed or suppressed, usually by the use of antibiotics, causing an imbalance of bad bacteria over good.

Fecal transplant was first documented in 4th century China, known as “yellow soup”.
It has been used for over 100 years in veterinary medicine, and has been used regularly for decades in many countries as the first line of defense, or treatment of choice, for C. diff. It is customary in many areas of the world for a newborn infant to receive a tiny amount of the mother’s stool by mouth, thought to provide immediate population of good bacteria in the baby’s colon, thereby jump-starting the baby’s immune system.

Fecal transplant has been used in the U.S., sporadically since the 1950′s, without much regulation. It has gained popularity in the U.S. in the past few years, although experts estimate that total number of treatments to date in the U.S. remains below 500 patients.

 

Infusion procedure

 

  1. Collect donor stool in appropriate container.  Place immediately into the blender with half teaspoon of the psyllium husks and between 100 – 400mls of normal saline (the volume of saline needed to make mixture ‘pourable’).

 

  1. This should be blended for approximately 15 seconds.

 

  1. Ensure the white ball in the bag is removed and the white clip is closed on the tubing.  Pour this mixture into the enema bag via the red cap.  Eliminate as much air as possible and close the red cap.

 

  1. Once preparation is complete, recipient will lie on their LEFT side in the foetal position with lower half of body elevated.

 

  1. Lubricate the rectal tip and gently insert the tip into the anus until you reach halfway of the blue tip..  Slowly unclamp the enema bag after hanging the bag up which will to commence the infusion.  Allow 5-10 minutes for infusion.

 

  1. Once infusion has been completed, clamp the tubing and gently remove the rectal tip (still attached to the tubing and bag).  Discard the enema bag and tip and ‘double bag’ for disposal.

 

  1. You then  remain on your left side, massaging your abdomen  for approximately 10 mins. Repeat this massage, lying on back,  stomach and completing on your right side.

 

  1. This procedure is repeated each day for 5 – 10 days approximately.

 

  1. If you difficulty retaining the enema you can take Imodium or codeine as required.

REMEMBER IT’S QUALITY NOT QUANTITY

Blood work and stool testing for patients and donors

 

HEP B  &  C, HIV, CMV, EBV, RPR, TOXO SEROLOGY

 

  1. B)              STOOL TEST FOR:              a)  CELLS
  2. b)PARASITES IN SAF FIXATIVE
  3. c)CULTURE  INCLUDING CL DIFFICLE

& TOXIN, YERSINIA,AEROMONAS & CAMP JEJUNI

  1. d)ANTI – ADHESION ANTIBODY FOR
  2. HISTOLYTICA.

 

  1. C)                    FBC, ESR, B12, FOLATE, TSH, ANA, U& E, CREAT,

GLUC, LFTs.

DONOR INSTRUCTIONS

SELECTION OF DONORS

Donors are selected by the recipient on the  following criteria:

¨       The potential donor must have  a healthy bowel motion every day.

¨       No history of bowel problems (eg no constipation, diarrhoea, colitis etc)

¨       Is not on any medications that may interfere with stool viability (eg antibiotics).

As a potential donor you will be fully screened to ensure that you are free from infection.  This involves a blood sample and stool tests as per the enclosed protocol.

DIETARY CHANGES

The person receiving your stool (recipient) will be relying on the donor to pass a bowel motion every day.  We highly recommend that you start the following changes  at least one week prior to  the commencement of the infusion.  These changes include :

 

  1. Avoiding foods at risk of contamination

 

¨       Avoid shellfish, prawns, oysters and processed meats such as salami, ham and sausages.

¨       Avoid all antibiotics.

 

  1. You must commence a high fibre diet to improve the quality of your flora

 

¨       All breads, cereals and grain should be wholemeal.  This includes bread, pasta, rice and breakfast cereals.

 

¨       Eat plenty of fresh vegetables (with the exception of corn).

 

¨       Include beans and pulses in your diet (lentils, chickpeas, beans, hommos)

 

¨       Eat at least two pieces of fruit per day

 

¨       Drink at least 1 litre of water per day.

 

MEAL SUGGESTIONS

Breakfast

 

¨       At breakfast have wholemeal toast, muesli or a high fibre cereal.  Maybe include some yoghurt.

 

Lunch

 

¨       Salad sandwich with wholemeal bread and whatever filling you wish and a piece of fruit.

¨       Pasta with vegies

¨       Noodles with vegies

 

Dinner

 

¨       Pasta with meat, sauce and vegies

¨       Meat, fish or chicken with two types of vegies or salad and potatoes.

¨       Stir fried vegies (with or without meat) with noodles or brown rice.

¨       Brown rice with beans or lentils.

YOUR RESPONSIBILITIES AS A  DONOR

As a donor it is vitally important that you understand the instructions mentioned.  There are two major points:

 

  1. You need to make sufficient dietary and lifestyle changes for the duration of the recipient’s treatment to ensure that you will pass a bowel motion every day.

 

  1. If you experience any of the following, please withdraw from donating:

 

  • Diarrhoea
  • Vomiting
  • Cold / flu
  • Any antibiotic usage

 

HOW TO ENSURE YOU “GO” EVERY DAY

 

This is the biggest concern of the donor.  By following the dietary recommendations above ,you should have no problem passing a bowel motion every day.

 


Ensure the white ball in the bag is removed and the white clip is closed on the tubing.  Pour this mixture into the enema bag via the red cap.  Eliminate as much air as possible and close the red cap.

  1. Once preparation is complete, recipient will lie on their LEFT side in the foetal position with lower half of body elevated.

 

  1. Lubricate the rectal tip and gently insert the tip into the anus until you reach halfway of the blue tip..  Slowly unclamp the enema bag after hanging the bag up which will to commence the infusion.  Allow 5-10 minutes for infusion.

 

  1. Once infusion has been completed, clamp the tubing and gently remove the rectal tip (still attached to the tubing and bag).  Discard the enema bag and tip and ‘double bag’ for disposal.

 

  1. You then  remain on your left side, massaging your abdomen  for approximately 10 mins. Repeat this massage, lying on back,  stomach and completing on your right side.

 

  1. This procedure is repeated each day for 5 – 10 days approximately.

 

  1. If you difficulty retaining the enema you can take Imodium or codeine as required.

 

 

 

SELECTION OF DONORS

 

Donors are selected by the recipient on the  following criteria:

 

¨       The potential donor must have  a healthy bowel motion every day.

¨       No history of bowel problems (eg no constipation, diarrhoea, colitis etc)

¨       Is not on any medications that may interfere with stool viability (eg antibiotics).

 

As a potential donor you will be fully screened to ensure that you are free from infection.  This involves a blood sample and stool tests as per the enclosed protocol.

DIETARY CHANGES

The person receiving your stool (recipient) will be relying on the donor to pass a bowel motion every day.  We highly recommend that you start the following changes  at least one week prior to  the commencement of the infusion.  These changes include :

 

  1. Avoiding foods at risk of contamination

 

¨       Avoid shellfish, prawns, oysters and processed meats such as salami, ham and sausages.

¨       Avoid all antibiotics.

 

  1. You must commence a high fibre diet to improve the quality of your flora

 

¨       All breads, cereals and grain should be wholemeal.  This includes bread, pasta, rice and breakfast cereals.

 

¨       Eat plenty of fresh vegetables (with the exception of corn).

 

¨       Include beans and pulses in your diet (lentils, chickpeas, beans, hommos)

 

¨       Eat at least two pieces of fruit per day

 

¨       Drink at least 1 litre of water per day.

 

MEAL SUGGESTIONS

 

Breakfast

 

¨       At breakfast have wholemeal toast, muesli or a high fibre cereal.  Maybe include some yoghurt.

 

Lunch

 

¨       Salad sandwich with wholemeal bread and whatever filling you wish and a piece of fruit.

¨       Pasta with vegies

¨       Noodles with vegies

 

Dinner

 

¨       Pasta with meat, sauce and vegies

¨       Meat, fish or chicken with two types of vegies or salad and potatoes.

¨       Stir fried vegies (with or without meat) with noodles or brown rice.

¨       Brown rice with beans or lentils.

YOUR RESPONSIBILITIES AS A  DONOR

As a donor it is vitally important that you understand the instructions mentioned.  There are two major points:

 

  1. You need to make sufficient dietary and lifestyle changes for the duration of the recipient’s treatment to ensure that you will pass a bowel motion every day.

 

  1. If you experience any of the following, please withdraw from donating:

 

  • Diarrhoea
  • Vomiting
  • Cold / flu
  • Any antibiotic usage

 

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