Clinical evidence to date

Case report and case series data supportive of the efficacy of FMT as treatment for recurrent/refractory Clostridium difficile infection (CDI) have slowly accumulated over many decades, but randomised trial data supporting its use for this indication were lacking until as recently as 2013.1 There are now a growing number of randomised studies/trials that have consistently demonstrated the much greater efficacy of FMT than that of vancomycin in inducing remission from recurrent/refractory CDI; success from a single FMT is quoted at ≥80%, and for two FMTs as ≥90%.1 FMT appears to be similarly as efficacious for this indication regardless of whether the transplant is delivered via the upper gastrointestinal (GI)1 or lower GI tract.2 ,3

Based on this clinical evidence (along with data supporting the cost effectiveness of FMT in comparison with other treatment strategies),4 FMT has now been accepted as an appropriate treatment option for recurrent/refractory CDI by the National Institute for Health and Care Excellence,5 Public Health England6 and European guidelines.7

There is increasing recognition that a distinctive pattern of alteration of the structure of the gut microbiota (or ‘dysbiosis’) appears to characterise a number of conditions, including inflammatory bowel disease and metabolic syndrome. Although it remains largely unclear as to whether these microbiota changes are a cause of these conditions, consequence or incidental, there is much interest as to whether manipulation of the gut microbiota might be a …