Fecal microbiota transplantation: facts and controversies.
OBJECTIVE
To review the current evidence on fecal microbiota transplantations (FMTs) for recurrent Clostridium difficile infections (CDIs), metabolic syndrome and inflammatory bowel disease.


RESULTS
Recently, a randomized trial confirmed the efficacy of this treatment strategy in patients with recurrent CDI. For other disorders, evidence is still limited. To date, studies have been performed to try and influence the course of metabolic syndrome and inflammatory bowel disease.


CONCLUSIONS
There is increasing interest in the role of altered microbiota in the development of a myriad of diseases. Together with new insights comes an interest in influencing this altered microbiota as a potential target for therapy. FMTs are effective against recurrent CDI, a disorder caused by disruption of the normal microbiota. Restoration of intestinal flora and thereby restoration of colonization resistance is thought to be the mechanism responsible for cure. With the developments in FMT and the extension of this treatment modality to both intestinal and extra-intestinal diseases, a new field of targeted therapy awaits. The ultimate goal is the development of powerful probiotic regimens that can replace FMT. Currently, FMT should only be given in a strict experimental setting for other conditions than CDI.
aDepartment of Internal Medicine, Academic Medical Center, Amsterdam bDepartment of Gastroenterology, Haga Teaching Hospital, The Hague, the Netherlands.
Els
E
van Nood
Peter
P
Speelman
Max
M
Nieuwdorp
Josbert
J
Keller
D002985:Clinical Protocols; D046148:Donor Selection / Q000379:methods; D004761:Enterocolitis, Pseudomembranous / Q000628:therapy*; D005243:Feces / Q000382:microbiology*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy; D007422:Intestines / Q000382:microbiology; D024821:Metabolic Syndrome / Q000628:therapy; D064307:Microbiota; D012008:Recurrence; D016378:Tissue Transplantation / Q000009:adverse effects / Q000379:methods*