What is a stool transplantation?
A stool transplant is the transfer of stool or the bacteria contained in stool from a healthy donor into the intestine of a patient. The aim of stool transplantation is to restore the irreparably damaged intestinal flora of the patient and thus to produce or at least promote a physiological, i.e. healthy microbiome. The procedure, which has so far only been used under strict indication, thus falls under the umbrella term of microbiome transfer. All methods of transferring material containing bacteria from one individual to another are described as such. Common synonyms for stool transplantation are “stool transfusion” and also “fecal microbiota transplantation” (FMT).
For whom are chair transplants suitable?
Up to now, stool transplants have not been officially approved as a form of therapy, but are considered an “individual healing experiment” if the indication is established accordingly. The only common application is in the case of a symptomatic intestinal infection caused by the bacterium Clostridium difficile. This intestinal inflammation is also called pseudomembranous colitis.
It occurs mainly as a result of prolonged antibiotic therapy in the ward, which has damaged the natural, healthy intestinal flora. Clostridia, which are resistant to many commonly used antibiotics, thus receive an artificially generated selection advantage and can multiply undisturbed. A further prerequisite for a stool transplantation is the failure of all other common therapy attempts.
In this case the indication of a “therapy-refractory CDAD” (Clostridium difficile associated diarrhea) can be given. Apart from this, a number of other possible indications are currently being investigated. For example, there are discreet indications that stool transplantation may also be helpful in cases of chronic inflammatory bowel disease or even irritable bowel syndrome.
Now that the treatment of Clostridial infection of the small and large intestine by means of a stool transplantation is becoming more and more established, research is also increasingly interested in the treatment of other (intestinal) diseases by the procedure. The main focus here is on the chronic inflammatory bowel diseases Crohn’s disease and ulcerative colitis. However, there is also hope in the case of irritable bowel syndrome that patients can be helped by inserting healthy donor stools into the bowel.
Since the cause of irritable bowel syndrome is still largely unexplained today and the term irritable bowel actually seems to be more of a collective term for various diseases, a great deal of research is still needed on the subject. There are virtually no studies, case collections or experiences worth mentioning regarding the treatment of irritable bowel syndrome by means of a stool transplant. Recent successes in the treatment of chronic Clostridium difficile infections nourish the hope for a cure or at least an alleviation of symptoms not only in irritable bowel syndrome patients.
Research is also currently being conducted into the treatment of the chronic inflammatory bowel diseases Crohn’s disease and ulcerative colitis by means of a stool transplant. However, most of the controlled studies carried out to date have produced mostly disappointing results. Only in children did a study in a small patient group show a clear clinical response.
In order to be able to make more precise statements on this, several more years and studies will nevertheless have to pass. While a stool transplantation was initially only performed in patients with non-therapeutic diarrhea caused by a bacterial infection with Clostridium difficile (CDAD), there are now individual studies examining the effectiveness of stool transplantation in chronic inflammatory bowel diseases (including Crohn’s disease). First study results show an effectiveness of stool transplantation in Crohn’s disease patients.
However, there are not yet sufficient data on the effect and possible side effects. Further studies are required before stool transplantation can be approved for the treatment of Crohn’s disease. Individual studies have shown that an altered intestinal flora increases the risk of a special form of multiple sclerosis (MS).
At the same time, MS patients show an increased concentration of specific bacteria in the intestine.For this reason, a stool transplantation is considered a possible therapy option for the treatment of multiple sclerosis. Individual studies have been initiated, but first results are still pending and the efficacy of stool transplantation in multiple sclerosis has not yet been proven. Studies in mouse models have shown a correlation between body weight and intestinal flora.
For example, normal weight mice that received stool transplants from obese mice also became overweight. This discovery has led to the initiation of individual studies to investigate stool transplantation as a therapeutic option for the treatment of obesity. Initial results on the efficacy of stool transplantation in obesity are still pending. Therefore, stool transplantation is currently not yet a therapeutic option for weight loss. Numerous further investigations and studies are required for the treatment of obesity by means of stool transplantation.
