Fecal matter transplant

A fecal matter transplant or fecal microbiota transplant (FMT) is a therapy that involves the transfer of fecal waste from a healthy donor to the colon of a patient. At present, in the U.S., fecal matter transplant is regulated by the FDA and is only approved for use in severe or reoccurring c. difficile infections. In the UK, some clinics, such as the Taymount Clinic offer FMT for a wide range of GI and chronic illnesses.

The FDA regulation hasn't stopped people with other illnesses, especially GI illnesses, such as ulcerative colitis or irritable bowel syndrome, from experimenting on their own with FMT. Recipes for do-it-yourself FMT are abundant online, including Dr. Sarah Myhill's protocol, Probiotic Therapy Home Infusion Protocol.

Methods
Fecal matter from a person with healthy gut flora is mixed with saline, strained, inserted into the patient with Clostridium difficile colitis via a colonoscopy, endoscopy, sigmoidoscopy, or enema in order to recolonize the ill person's bowels. It is recommended that the donor be someone close to the patient, with the first choice being a spouse or significant other, but other close friends, relatives, or a “universal donor” source may be warranted. The physician should ensure that the “universal donor” source employs rigorous screening and testing standards. Testing includes screening the donors’ blood for diseases like HIV and hepatitis and testing their stool for bacterial pathogens, giardia and cryptosporidium, parasites, and C. difficile.

Chronic fatigue syndrome
Much discussion has been on the topic of microbiome health and its relationship to ME/CFS. This discussion has included FMT.

In 2012, in Australia, a study using a combination of fecal matter transplants and an oral course of cultured bacteria reported a 70% rate of improvement of sleep and "lethargy/fatigue" symptoms in Fukuda CFS patients recruited from a clinic for digestive disorders. The authors reported a 58% success rate at long term followup, but only 12 patients (out of the original 60) were contacted at that point. Accordingly, the long-term followup results would not have been statistically significant.

However, that study neglected to use any objective outcome measurements, and the symptoms used to determine a successful outcome regarding "CFS symptoms" did not account for physical limitations or many other ME/CFS symptoms. Furthermore, all patients were recruited from a clinic for digestive disorders, which would suggest that they were not typical ME/CFS patients. Because the recruitment criteria did not require post-exertional malaise, the results may not be applicable to ME/CFS patients meeting more stringent criteria

This study has not been replicated, and no other studies for FMT and ME/CFS have been conducted. Accordingly, the existing evidence base in favor of this therapy is very weak.

Learn more

 * 2012, The GI Microbiome and its Role in Chronic Fatigue Syndrome: A Summary of Bacteriotherapy (Thomas J. Borody, Anna Nowak, Sarah Finalayson)