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    Fecal Microbiota Transplantation
    Institutes of Transplant - Apollo Hospital

    Fecal Microbiota Transplantation

    Unravelling the mysteries of the GUT …
    Learn about fecal microbiota transplantation (FMT) as a game-changer in restoring GUT balance.

    Shared are some insights on combating ailments through probiotics, diet tweaks and FMT.

    The procedure of moving a medically prepared fecal sample from one person’s gut to another is known as fecal transplantation. The sample contains thousands of bacteria that are beneficial to medicine.

    The majority of these advantages are currently being studied and the practice is evolving.

    Nonetheless, fecal transplants are prescribed by medical professionals for multiple ailments of the Gut and the Brain.

    What is a Fecal Microbiota Transplant (FMT)?

    A novel medical technique that is gaining popularity for its effectiveness in treating a range of gastrointestinal disorders is stool transplantation, or fecal microbiota transplantation (FMT). The goal of this transfer is to bring the gut microbiota back into equilibrium, which is crucial for preserving general health and avoiding disease. In order to restore a healthy balance of gut bacteria, this therapy involves transferring fecal matter from a healthy donor into the recipient’s digestive system.

    Fecal Microbiota Transplantation (FMT) is a highly effective treatment for recurrent or refractory C. diff infections. It restores microbial balance in the gut and resolves symptoms. Children and adults can both undergo FMT.

    Indications for FMT include the following:

    • Recurrent Clostridium difficile infection (CDI): FMT has shown remarkably high success rates in treating CDI, which recurs often and is resistant to standard antibiotic treatment.
    • Inflammatory Bowel Disease (IBD): Although further study is required to confirm its effectiveness, preliminary findings indicate that FMT may lessen the symptoms of Crohn’s disease and ulcerative colitis.
    • Irritable Bowel Syndrome (IBS): FMT has the potential to regulate gut flora and enhance IBS symptoms, including pain in the abdomen and irregular bowel movements.
    • Metabolic diseases: New research suggests that FMT could play a role in managing metabolic diseases such as obesity and metabolic syndrome by altering host metabolism.
    • Neurological Disorders: Preclinical research has suggested the importance of the gut-brain axis in neurological disorders such as depression and Parkinson’s disease. FMT canmodulates this axis, which might improve the general well-being of afflicted persons and alleviate symptoms.

    To Whom Should A Fecal Microbiota Transplant (FMT) Not Be Recommended?

    Those with weakened immune systems, such as organ transplant patients or those on chemotherapy, shouldn’t have a fecal microbiota transplant (FMT) because of the potential for infections or other problems. Additionally, patients who have bowel perforations or toxic megacolon are not good candidates for FMT since the surgery might make their situation worse. FMT should also be avoided until a patient’s health is stabilized if they have uncontrolled or untreated medical disorders such as active inflammatory bowel disease or gastrointestinal bleeding. The safety and effectiveness of FMT operations depend on careful patient selection and comprehensive medical evaluation.

    Donors of Fecal Microbiota Transplantation

    In order to ensure safety and efficacy in fecal microbiota transplantation (FMT), donor selection is essential. Whether you receive a transplant from a pool of carefully selected donors or select your own donor will depend on how your doctor conducts FMT. Donors undergo extensive screening procedures that evaluate their general health and the makeup of their gut flora. An adult in good health who meets the following criteria is a viable donor for fecal transplants:

    • Has not been exposed to antibiotics in the previous six months.
    • Is not immunocompromised
    • Not susceptible to infectious diseases.
    • Doesn’t have any long-term digestive conditions, such as inflammatory colon illness.

    Donors also provide comprehensive medical histories and undergo extensive laboratory testing to rule out infections and guarantee compatibility with the recipient. Healthcare professionals can reduce the chance of unfavorable outcomes and optimize the therapeutic potential of FMT by choosing competent donors who fulfill strict requirements. Further investigation seeks to clarify ideal donor attributes and improve selection standards to improve therapeutic results and expand the range of medical disorders for which FMT may be used.

    How Does FMT Work?

    FMT operates on the principle of restoring microbial diversity within the gut microbiota, which serves as a complex ecosystem comprising trillions of microorganisms. Through fecal transplantation, the patient receives “good” bacteria from the donor feces. The growth of healthy bacteria stops the recurrence of C. diff. Once the transplanted microbiota is inserted into the recipient’s digestive system, it interacts with the native microbial population to produce many advantageous outcomes. The human immune system and the gut microbiota are intimately correlated, affecting inflammation and immunological responses. By boosting tolerance and reducing inflammatory processes linked to a number of disorders, FMT may alter immune function.

    Preparing for FMT

    Donors and receivers undergo extensive screening processes before having FMT to guarantee safety and effectiveness. Donors undergo a comprehensive screening process to determine their general health, freedom from infectious illnesses, and microbiome compatibility for transplantation. To determine underlying diseases and evaluate the risk-benefit profile of FMT, recipients undergo comprehensive medical evaluations. Ensure that your physician knows all the medications you take and any sensitivities you may have.

    About the FMT Procedure

    There are several ways to introduce fecal bacteria into your gastrointestinal system. Methods for fecal transplantation include:

    • Colonoscopy: During a colonoscopy, your rectum is used to insert a thin tube linked to a small camera into your colon. The colonoscope tube gradually divides your gut into two halves. Doctors can use the tube to provide medications, such as fecal bacteria.
    • Upper endoscopy: This method, which involves the insertion of a tube through your mouth or nose into your esophagus and stomach or small intestine, is an alternative for those who cannot undergo a colonoscopy. However, it has a lower success rate due to the need for the microbiota to pass through the small intestine before reaching the colon.
    • Enema: An enema administers medication by inserting a tube into your rectum. Unlike in your small intestine, fecal microbiota may go from your rectum into your colon without risk of causing any major environmental changes.
    • Oral capsule: These innovative capsules, containing freeze-dried, live fecal microbiota, are commonly referred to as fecal transplant tablets. They are designed to remain intact until they reach your intestines, ensuring the safe and effective delivery of the microbiota.

    Recovery Following a Fecal Transplant
    Following a fecal transplant, recovery usually entails a slow improvement of gastrointestinal symptoms and a return to gut health. Following the operation, patients may get relief from symptoms, including bloating, diarrhea, and stomach discomfort, in a few days to weeks.

    Adhere to any food advice or prescription schedules included in the post-transplant care instructions given by medical professionals. Follow-up sessions are planned on a regular basis to track advancement, evaluate response to therapy, and handle any problems or challenges that might come up. With the right care and supervision, patients can anticipate a full recovery and enhanced quality of life following a fecal transplant.

    Does The Treatment Of Fecal Microbiota Transplantation Have Any Significant Risks?
    While fecal transplant therapy is generally considered safe and effective, there are potential risks and complications associated with the procedure. Serious risks include transmission of infectious diseases or pathogens from the donor to the recipient, allergic reactions to donor stool components, and rare gastrointestinal perforation or infection.

    Some short side effects that might occur if you are given FMT during a colonoscopy include:

    • Abdominal swelling and gas
    • Pain during therapy due to air becoming lodged in the large intestine
    • Irregular bowel movements brought on by antidiarrheal medication
    • A little leakage of the transplant fluid from the rectum* Typical risks linked with a colonoscopy include infection, bleeding, a rupture or hole that requires surgery, and risks related to anesthesia

    Additional FMT risks are as follows:

    • Infection: Despite extensive testing of the feces used in FMT, there is a small chance that the receiver may become infected from the donor.
    • Unexpected reactions from the body: Rarely, people may encounter unanticipated physiological changes as a result of the changing gut flora, such as modifications in metabolism or immune system response.
    • Long-term risks: The risks associated with FMT in the long run are yet unclear. Researchers are now investigating the possible long-term effects of altered gut flora on a variety of health-related issues.

    Conclusion

    Fecal microbiota transplantation (FMT) is a potentially effective treatment method for a variety of gastrointestinal and non-gastrointestinal disorders. By reestablishing the balance of gut microbiota and enhancing health and well-being, FMT holds the potential to revolutionize the treatment landscape for various medical conditions, offering hope for improved outcomes and quality of life for patients worldwide.

    Prof. (Dr.) Narasimhaiah Srinivasaiah, MBBS, MD, MRCS (Eng, Ed,Glas, Ireland), FRCS (CCST), FEBS (Europe), EARCS (Lisbon), PGDMLE (NLSIU), GMHE (IIMB).
    Associate Professor of Surgery, Apollo Hospitals
    Head of colorectal services, Karnataka region
    Senior Consultant Colorectal surgeon (Colorectal, Peritoneal & Pelvic Oncology).
    Laparoscopic & Robotic Surgeon – Apollo Institute of Colorectal Surgery (AICRS)
    Director, Health Sciences Park (HSP) – Bangalore Apollo Hospital, 154 / 11, Bannerghatta Road Opp. I.I.M,
    Bangalore – 560 076
    Tel (Mob): 0091 – 81970 88434.
    Email (P): bangalorebowelcare@gmail.com
    https://www.linkedin.com/in/narasimhaiah-srinivasaiah-a741177/


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