NEW DELHI: Most of us have heard of heart, liver and kidney transplants. But not many know about poop transplant or Faecal microbiota transplantation (FMT).
FMT, also known as stool transplant, is approved worldwide for treatment of colonic inflammation due to Clostridium difficile infection or C. diff, a bacterium that causes an infection of the colon, the longest part of the large intestine. It often occurs after using antibiotic medicines.
However, there is emerging evidence for its use for inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), liver disease, food allergies, and even for some neurological conditions.
As India is seeing a rising use of antibiotics and recurrent gut disorders, experts here are turning to FMT, a medical procedure in which a small sample of stool (faeces) is transplanted from a healthy colon into a diseased colon through rectal enema, colonoscopy, per-oral enteroscopy, nasogastric tube, capsules or endoscopy to restore gut flora.
“We have conducted more than 400 stool transplants, including patients from nine countries,” said Dr. (Col) Avnish Seth, Chairman, Gastroenterology and Hepato-Biliary Sciences, Manipal Hospitals NCR Cluster.
“The goal of this treatment is to restore a balanced and healthy gut microbiome, which plays a crucial role in overall health,” he told this paper.
Although the first FMT - considered to be a highly effective procedure - in India was done by Dr Seth in 2014, a year after the USFDA approved it for recurrent Clostridium difficile infection, it is now slowly taking off in some centres in India.
However, so far, there is no registry to maintain data.
“Over the last few years, stool transplantation has been evolving from a research tool to a low-cost, readily accessible and safe treatment option,” added Dr Seth, who is also Chairman Restorative Institute of Gut Health and Transplant of Stool (RIGHTs), the first department of its kind in India.
“The demand for the procedure is increasing due to rising use of antibiotics and recurrent gut disorders,” said Dr Seth, who is the pioneer in performing stool transplants for the last 12 years.
While research is still ongoing, FMT is being explored as a potential treatment for conditions such as IBD, IBS, Alcoholic Liver Disease, Alcohol Use Disorder, Parkinson’s Disease, Autism Spectrum Disorder and even Metabolic Syndrome and Obesity.
As around 10% of the Indian population is suffering from IBS and gut health-related issues, FMT may be life changing for a large number of people.
“When donor evaluation is done as per standard protocol, and recipients are not immunocompromised, no significant adverse effect is reported after use in hundreds of patients. Few individuals develop self-limiting fever, abdominal cramps and loose stools. These are expected side effects and shouldn’t be a cause for concern. They usually pass in a day or two,” he added.
He further said that donors are selected based on their being healthy, aged five or more with no high-risk lifestyle, no chronic gastrointestinal diseases, no use of antibiotics in the past three months, and preferably vegetarian, from a rural background.
While the concept of using faecal matter to treat illnesses dates back centuries, modern FMT has gained traction after 2013, when clinical studies highlighted its effectiveness in treating recurrent Clostridium difficile (C. diff) infections, with success rates exceeding 90%.
While one treatment is usually enough for C. diff, but for other disorders, a six monthly booster dose with a maintenance FMT is needed, he added.
C. diff causes severe diarrhoea and colitis, primarily affecting people in healthcare settings after antibiotic use disrupts normal gut flora.
“This treatment is considered unique as, unlike traditional treatments that use medications or antibiotics to combat infections, FMT takes a biological approach by reintroducing healthy, balanced microbiota directly from a donor. This is especially important because gut bacteria play a vital role in digestion, immune response, and overall well-being,” Dr Seth added.
Today, FMT is being used in several countries. Australia was the first to conduct extensive research and publications in this field.
