Fecal microbiota transplantation: The state of the art

Abstract

Clostridium difficile infection (CDI) is an emerging problem in terms of incidence, morbidity and mortality. Currently available treatment options are not always effective, especially in cases of recurrent/refractory or complicated CDI. The gut microbiota transplantation is a technique that has been sporadically practiced since the '50s, but its clinical efficacy has only recently been supported by scientific evidence. In the present article, we report the pathophysiological basis and the clinical indications of this technique that, in light of its low cost, and proven efficacy and safety, is likely to become part of the management guidelines of difficult cases of CDI in the near future.cases, the signs and symptoms of CDI usually reappear after discontinuation of antibiotic treatment. Actually, the current international guidelines declare the existence of a gap in the management of these clinical situations.4 Unconventional therapies have been proposed as alternative or adjunctive treatment to the classic metronidazole and vancomycin, such as the use of intravenous immunoglobulin, and others like probiotics, and chelating agents. However, the results in terms of clinical cure have been far from satisfactory. In light of these therapeutic limitations the technique of fecal bacteriotherapy was rediscovered, with the rationale of a real organ transplant. The first reported fecal transplant in humans in the literature dates back to 1958.5 The use of fecal bacteriotherapy was in fact reported in the literature for about 50 years, but until 2013 no randomized trial was ever been published. Over the last few years, the term intestinal flora (now considered obsolete) has been gradually replaced with that of gut microbiota, thus indicating the growing awareness of the existence of an actual organ responsible of multiple physiological functions (i.e. energy metabolism and immune system), similarly to what has happened with the adipose tissue in metabolic diseases.