What is C. difficile? Would I know if I had it? Should I get tested in case I qualify for FMT?
Clostridium difficile infection (CDI), popularly known as C difficile or C diff, is an opportunistic infection that causes inflammation of the colon, or colitis.
It is characterized by frequent watery diarrhea (3 times a day or more for 2 days or more) with abdominal cramping. Severe infection may be accompanied by fever, bloody watery diarrhea and painful abdominal cramping.
CDI sometimes occurs following the use of an antibiotic. The most common antibiotics that can create risk for CDI are broad-spectrum antibiotics, especially ampicillin, amoxicillin, cephalosporins, and clindamycin.
There are asymptomatic carriers of both toxigenic and non-toxigenic Clostridium difficile, meaning people who have these bacteria in their gut flora but who do not have symptoms. The prevalence of asymptomatic carriers may be as high as 15%.
You need to have a stool test ordered by your physician to diagnose a case of CDI.
CDI is also increasingly being found in people who have no risk factors and have not taken any antibiotics.
For more information about C diff infections, the American Gastroenterological Association has an excellent page here.
How likely is my condition (especially C. difficile) to return after FMT treatment?
There is currently very little data from randomized clinical trials, however, the clinical data that exists indicates that FMT has a very low recurrence rate, much lower than any antibiotic, especially in CDI that has already recurred multiple times.
Does age matter?
The standard recommendation is that donors should be older than 3 and younger than 60 because this is the age range with the greatest diversity of colon flora.
Does blood type matter?
Blood type does not appear to be important in having successful FMT. We do not have a large enough sample size to say for sure.
Do the medications taken and/or the food eaten by the donor matter during FMT?
Yes, in some instances. If you have specific concerns, we recommend that you schedule an appointment or an educational remote consult.
Would I be able to acquire OpenBiome donor stool through you?
We do not currently contract with OpenBiome for stool products. We do offer our own pre-screened donor bank.
What is the difference between human sourced probiotics and the FMT by capsules that you offer?
FMT capsules deliver an entire microbiome, including many strains of bacteria that are extremely difficult to culture. Human sourced probiotics are generally strains of bacteria sourced from humans and cultured in a lab. The closest thing to a synthetic FMT was developed by Elain Petrof’s lab in her RePOOPulate project, which uses an artificial colon to grow out 33 bacteria from the human colon.
Where can I find a donor? Can you put me in contact with your donors? Can you recommend a donor?
We are unable to give you access to our donors and we do not have the ability to recommend a donor for you. We will treat you using our donor in our clinic, and we can help screen your donor if they can come to our clinic in person to establish a doctor-patient relationship.
How much does FMT cost?
Please see our Fee Schedule for current pricing structure.
How long does the FMT treatment take?
For a retention enema treatment, you can expect to be in our clinic for a minimum of 1 hour, which includes a brief interview, having your vitals checked and then changing into a gown. Giving the enema takes anywhere from 15 minutes to 45 minutes, depending on the volume of the enema and your comfort level. We recommend retaining the enema for a minimum of 4 hours, some of our patients prefer to remain in the treatment room for the whole 4 hours, while the majority prefer to leave the clinic after the enema has been given.
For a capsules treatment, you can expect to be in the clinic for a minimum of 1 hour, which includes a brief interview and then about 30 minutes or more will elapse while we prepare and deliver the capsules in batches of 8-12 at a time. You might receive anywhere from 12-40 capsules depending on your donor.
Do you treat children?
Is your donor material prepared in an anaerobic environment or with minimal oxygen exposure?
We take precautions to minimize oxygen exposure during storage and processing, however, our process is not anaerobic. Strictly anaerobic conditions are not necessary to provide a high enough viability for effective fecal transplant product.
What methods of administration do you use for FMT?
We offer FMT via retention enema delivered rectally, or via capsules delivered orally.
What are the FDA requirements to qualify for FMT treatment of antibiotic resistant C. difficile?
You must have a C difficile infection which is not responding to standard therapies. You can read the entire statement on FDA discretionary enforcement here.
I had C. diff and have not been completely healthy since, but I don’t test positive now; what can I do?
We are licensed naturopathic physicians, so we have a great number of tools at our disposal to help resolve post-infectious IBS or other lingering symptoms. We use botanicals, supplements, diet and pharmaceuticals to address these symptoms. We may also suggest testing for food allergy and sensitivity or other diagnostic tests to determine underlying causes of your symptoms.
I am opposed to antibiotic treatment; can I just start with FMT to treat my C. difficile?
The FDA discretionary enforcement policy for FMT only allows FMT for Clostridium difficile infection that is not responding to standard therapies.
Do you have experience treating people with conditions other than C. difficile?
Yes. Prior to the FDA restrictions, Bright Medicine Clinic treated many conditions using FMT.
I have a J pouch, can I do FMT?
There is one reported case of the use of FMT for a case of pouchitis caused by C difficile infection. It was successful.
I no longer have a rectum, can I do FMT?
You may be a candidate for a fecal transplant using capsules.
I’ve read that you do retreats; how do I sign up?
We are not currently offering retreats.
Can I do FMT during a flare of my symptoms?
Yes, but you may have difficulty retaining the enema.
I am taking antibiotics; can I do FMT?
We begin FMT 24-48 hours after completion of an antibiotics course. We do not recommend doing FMT while taking antibiotics.
Can you recommend a provider of FMT in my area?
A good place to start is the Providers & Trials page on the Fecal Transplant Foundation website or theFind a Practitioner page on the American Gastroenterological Association FMT website. Please note that these lists are not at all exhaustive and you may have find a provider closer to you by calling gastroenterologists or infectious disease doctors and asking their offices.
Do you know of a provider who offers FMT for conditions other than C. difficile?
The FDA only allows FMT to be used for conditions other than C difficile in the setting of a clinical trial. To see what clinical trials are currently enrolling, search ‘fecal transplant‘ on Clinicaltrials.gov
Can I do FMT at home? Do you offer guidance?
Many people perform FMT at home. We offer remote educational consultations by Skype or telephone, or you can come in for an appointment. Please call 503.928.7605 to schedule.
I follow a very specific diet to avoid symptom flares; I am concerned about diet changes before/during FMT.
For treatment of C diff, there is no special diet you need to follow, other than restricting yourself to clear liquids for 24 hours prior to the procedure.
If you are planning a home treatment for a condition other than CDI, and you need tailored dietary guidance and support, we can answer your questions via remote educational consultation or an in-person appointment.
When is your clinical trial FMT for Ulcerative Colitis going to start?
Unfortunately, we do not have the resources to continue to seek approval for our proposed clinical trial FMT for Ulcerative Colitis in Adults and so at this time, it is on hold indefinitely.
Do you accept insurance? Will it cover FMT?
We do not currently bill insurance for FMT and it is often not covered well by insurance, however, we are happy to provide you with a superbill for you to submit on your own behalf.