European consensus conference endorses fecal transplantation for C. diff infection

Last Updated: 2017-01-23

By Will Boggs MD

NEW YORK (Reuters Health) - A European consensus conference endorses the use of fecal microbiota transplantation (FMT) in clinical practice for patients with Clostridium difficile infection, but stops short of recommending it for other indications.

"Statements regarding other indications for fecal microbiota transplantation than Clostridium difficile infection (inflammatory bowel disease, metabolic disorders, and irritable bowel disease) may be considered controversial, as the therapeutic role of FMT in these disorders is still not clear," said Dr. Giovanni Cammarota from Universita Cattolica del Sacro Cuore in Rome.

"Thus, the consensus established C. difficile infection to be the only indication for fecal microbiota transplantation in clinical practice, and its use for all other indications should be considered only in research settings," he told Reuters Health by email.

FMT has been shown to be highly effective against recurrent C. difficile infection and has been investigated in a number of other disorders associated with the alteration of gut microbiota, including ulcerative colitis and metabolic syndrome.

Dr. Cammarota and colleagues in the European FMT Working Group prepared their evidence-based consensus report to define indications and methodology for the use of FMT in the treatment of C. difficile infection, to discuss the suitability of FMT for other indications, and to address the minimum requirements needed to implement an FMT center.

They recommend the implementation of FMT in clinical practice as a treatment option for both mild and severe recurrent C. difficile infection and for refractory C. difficile infection.

For none of the other indications was there sufficient evidence to recommend FMT except in the context of research, they say.

Other recommendations detailed in the report, online January 13 in Gut, address donor selection and testing, preparation of fecal material, clinical management and fecal delivery, and patient monitoring.

The group strongly recommends development of referral FMT centers for the treatment of C. difficile infection in hospitals with appropriate expertise and facilities and strongly encourages specific training on FMT processes for members actively involved in those centers.

"We expect that these recommendations will be followed at a national level in different countries," Dr. Cammarota said. "Moreover, we hope that this consensus will boost the implementation and diffusion of fecal transplant-centers worldwide, as well as will help solving regulatory issues related to the procedure in different countries."

"The experience resulting from a fecal transplant approach to C. difficile could be translated in terms of scientific information, technical know-how, and knowledge dissemination to other research areas, with the ultimate goal of understanding the role that gut microbiota may play in other clinical conditions," he added.

SOURCE: http://bit.ly/2j4Px3Z

Gut 2017.