IN THE TREATMENT OF WHICH DISEASES IS FECAL MICROBIAL TRANSPLANTATION PERFORMED?
FECAL TRANSPLANTATION is performed to treat digestive flora damage, pathogen colonization in the intestines, autoimmune diseases, leaky gut syndrome, chronic diarrhea, ulcerative colitis, Crohn’s disease, Celiac disease, Lactose intolerance, Celiac Like Syndrome, IBS disease, food intolerances, Alzheimer’s disease, Autism.
WHAT IS A FECAL TRANSPLANT FOR?
Fecal transplantation aims to increase the biodiversity of intestinal flora in patients with impaired, damaged or reduced biodiversity of intestinal flora.
HOW IS FECAL MICROBIAL TRANSPLANTATION PERFORMED?
Fecal transplantation is the process of collecting fecal material from at least one healthy fecal donor, subjecting the collected material to a number of procedures, and transplanting it into the patient’s digestive system through endoscopy and colonoscopy.
HOW MANY TYPES OF FECAL TRANSPLANTS ARE PERFORMED?
- Fecal transplant from one donor to a single anatomical site
- Fecal transplant from multiple donors to a single anatomical site
- Fecal transplant from one donor to multiple anatomical sites
- Fecal transplant from multiple donors to multiple anatomical sites
WHOSE FECES ARE USED IN FECAL TRANSPLANTATION?
For fecal transplantation, healthy and biodiverse human feces are used.
DOES IT CAUSE HARM TO ME IF SOMEONE ELSE’S FECES IS LEFT IN MY INTESTINES?
The material that is transplanted after proper processing is actually not feces but the intestinal flora of a healthy person. Although it is popularly called Stool Transplantation, the true name of the procedure is Fecal Microbial Transplantation as named in the world literature. That is to say, the procedure we call stool transplantation is referred to as FMT in the world literature.
The procedure involves highly sophisticated steps. It is not as simple as transplanting feces into someone else’s intestine. Unless performed by experienced specialists in this field, the procedure is not likely to yield any benefit. However, if performed by qualified specialists, it improves the patient’s quality of life without causing any harm.
WHAT GOOD WILL THE FECAL TRANSPLANT DO ME?
The transplantation of richer and more biodiverse flora is aimed at eliminating dysfunctions in your intestines caused by flora deficiency.
IS GENETIC KINSHIP SOUGHT BETWEEN THE STOOL DONOR AND THE RECIPIENT?
No. The donor and recipient do not need to be genetically related.
CAN A FECAL TRANSPLANT BE PERFORMED WITH A DONOR OF THE OPPOSITE SEX?
It is preferable, but not mandatory, that the donor and recipient are of the same sex.
SHOULD THE DONOR AND RECIPIENT BE CLOSER IN AGE IN FECAL TRANSPLANTATION?
Transplants are made between people of similar age, especially in the pediatric age group. However, this is not required in adults. Healthy adults between the ages of 18 and 50 are eligible to be donors.
IS IT ALLOWED TO HAVE A FECAL TRANSPLANT DURING PREGNANCY?
Unless absolutely necessary, fecal transplants are not performed during pregnancy.
CAN PREGNANT WOMEN BE DONORS?
Unless there is no other alternative, pregnant women can also be donors.
IS IT ALLOWED TO HAVE A FECAL TRANSPLANT DURING BREASTFEEDING?
Breastfeeding is no barrier to fecal transplantation.
CAN BREASTFEEDING WOMEN BE DONORS?
Although not the first option, breastfeeding women can be donors.
WHERE AND HOW SHOULD THE DONOR DONATE THE FECES?
Feces should be donated in the hospital under the physical conditions and requirements set by the attending transplant physician.
HOW LONG AFTER THE COLLECTION OF THE FECES FROM THE DONOR IS IT TRANSPLANTED TO THE RECIPIENT?
As the material to be transplanted is a living tissue, the transplant is performed as soon as possible (30-45 minutes) following a very fast processing process after the feces are collected.
WHERE IS FECAL TRANSPLANTATION PERFORMED?
The fecal transplant is performed in the endoscopy department of the hospital, under the supervision of an anesthesiologist
DOES FECAL TRANSPLANTATION REQUIRE PRELIMINARY PREPARATION?
The transplant recipient should stop oral feeding for the last 12 hours before the procedure. The recipient should also follow a diet for the last 3 days and undergo bowel cleansing in the last 12 hours.
IS FECAL TRANSPLANT PERFORMED UNDER ANESTHESIA?
Rather than being fully anesthetized, the procedure is performed while the patient is asleep with partial anesthesia, called sedation, administered intravenously, with normal breathing continuing. The patient does not feel ANY PAIN during the procedure
HOW LONG DOES A FECAL TRANSPLANT TAKE?
The procedure is completed in a total of 10 to 20 minutes depending on the type of transplant to be performed. The patient is kept under observation in the hospital for 2 hours and then discharged.
DO I FEEL PAIN DURING A FECAL TRANSPLANT?
You will not feel pain during the procedure.
DO I NEED TO BE HOSPITALIZED BEFORE AND AFTER A FECAL TRANSPLANT?
No, you don’t.
IS THERE ANY RISK IN UNDERGOING A FECAL TRANSPLANT?
The risk of the procedure is the same as for endoscopy and colonoscopy. The risk is close to zero when the procedure is performed by experienced specialists.
HOW LONG DOES IT TAKE TO RETURN TO DAILY ROUTINES AFTER A FECAL TRANSPLANT?
You can return to your daily routines on the same day.
WHEN CAN I START EATING AGAIN AFTER A FECAL TRANSPLANT?
2 hours after the procedure.
WHEN IS THE ONSET OF THE FIRST EFFECTS AFTER A FECAL TRANSPLANT?
The treatment starts to exert its effects within hours after the procedure. However, optimum efficacy is seen at 3 weeks. The results of the fecal transplant are evaluated after the 6th month.
HOW IS THE DONOR SELECTED IN FECAL TRANSPLANTATION?
Eligibility to be a donor for fecal transplantation is based on the conditions in Table 1.
Table 1: Exclusion Criteria for Donor Selection in Total Gastrointestinal Flora Transplantation
|
Criteria for the Last Three Months |
Criteria for the Last Six Months |
Criteria for the Last Six Months |
|
-Those hospitalized -Those receiving intravenous therapy -Those vaccinated with live vaccines -Those taking antibiotics -Those who use antifungals -Those treated for parasites -Those who use antivirals -Those undergoing dental treatment -Those who have had surgical interventions -Those with a history of animal bites -Those with open injuries -Those with diarrhea -Unprotected sexual intercourse -Those with active infection -Those who gave birth -Travel to risk areas
|
-Those hospitalized
-Radiotherapy -Hormonotherapy -Immunosuppressive therapy -Intensive care treatment -Oral STOP over 7 days -Major surgical intervention -Blood transfusion -Those with a history of HAV infection -Contact with pesticides |
-Being a carrier of HIV infection (AIDS)
-Being a carrier of Hepatitis B infection -Being a carrier of Hepatitis C infection -Those with Chronic Infectious Diseases -Those with a BMI less than 20 kg/m2 -Those who are overweight with a BMI of more than 30 kg/m2 -Diabetic Patients on Insulin -Those with Autoimmune Diseases -Ulcerative Colitis Patients -Those with Crohn’s Disease -Those with Celiac Disease -Those with Lactose Intolerance -Those Diagnosed with Digestive System Cancer -Those who have had Digestive System Surgery (except Appendectomy) -Those breastfed less than 6 months -Those diagnosed with Leaky Gut Syndrome (LGS) -Drug addicts -Alcoholics -Healthcare workers -Prostitutes -Homosexuals -Those over 50 years of age -Schizophrenics -Autistics -Workers in toxic industries -Pregnant women -Those with oral stop for more than three weeks |
(*Source: Kanlioz M, Ekici U, Ferhatoğlu MF. Total Gastrointestinal Flora Transplantation in the Treatment of Leaky Gut Syndrome and Flora Loss. Cureus. 2022 Nov 3;14(11):e31071. doi: 10.7759/cureus.)
WHAT DETERMINES THE QUALITY OF A FECAL DONOR?
A person who meets the criteria in Table 1 above is designated as a “Fecal Donor Pre-Candidate”. The donor candidate then undergoes a series of biochemical and microbiological tests to determine whether the donor has an infectious disease. If the donor candidate also successfully passes these tests, then the donor quality is determined by scoring the donor candidate according to the criteria in Table 2 below.
Table 2: Donor Quality Scoring
| CRITERIA | SCORE | Donor Score | |||||||
| Age (years) | 0-20 years → 5 | 21-30 years→ 4 | 31-40 years→ 3 | 41-50 years→ 2 | 50+ years→ 1 | ||||
| Breast milk intake (months) | 1-6 months↓→ 6 | 6 months↑ → 9 | 9 months↑→ 12 | 12 months↑→15 | 24 months↑→18 | ||||
| Place of Residence | Rural → 10 | Urban→ 3 | Metropolis→ 0 | ||||||
| Chemotherapy | Not Received → 10 | Received → 0 | |||||||
| Radiotherapy | Not Received → 10 | Received → 0 | |||||||
| Radiotherapy | Not Received → 10 | Received → 0 | |||||||
| 3Weeks↑Antibiotics | Not Received → 10 | Received → 0 | |||||||
| Immunosuppressive Therapy | Not Received → 10 | Received→ 0 | |||||||
| Oral Stop | No oral stop→ 10 | 7 days ↓ → 5 | 7+ → 0 | ||||||
| Intensive care treatment | Not received→ 10 | 7 days↓ → 5 | 7+ → 0 | ||||||
| History of DM | No → 10 | Prediabetes→ 3 | Diabetes → 0 | ||||||
| Allergic diseases | No → 5 | Yes→ 0 | |||||||
| Autoimmune Disease | No → 5 | Yes→ 0 | |||||||
| Autoimmune disease in family members | No → 2 | Yes→ 0 | |||||||
| Industrial Food Consumption | No → 5 | Very little → 2 | Yes→ 0 | ||||||
| History of Dysentery | No → 5 | 3≤ → 2 | 4≥ → 0 | ||||||
| History of Gastroenteritis | No → 5 | 5≤ → 2 | 6≥ → 0 | ||||||
| GIS surgery | No → 10 | Yes→ 0 | |||||||
| Chronic medication use | No → 5 | Yes→ 0 | |||||||
| Nutritional disorder | No → 10 | Yes→ 0 | |||||||
| Alcohol use | No → 10 | Rarely→ 2 | Rarely → 0 | ||||||
| TOTAL SCORE: | |||||||||
| DONOR QUALITY BY SCORE
*125 points and ↑: Ideal Donor *100-124 points: Donor of Very Good Quality *90-99 points: Donor of Good Quality *80-89 points: Acceptable Donor *70-79 points: Donor of Poor Quality *69-↓ points: Donor of Very Poor Quality |
Total Donor Score:
|
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(*Source: Kanlioz M, Ekici U, Ferhatoğlu MF. Total Gastrointestinal Flora Transplantation in the Treatment of Leaky Gut Syndrome and Flora Loss. Cureus. 2022 Nov 3;14(11):e31071. doi: 10.7759/cureus.)
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