Perceptions of Fecal Microbiota Transplantation for Diarrhea Predominant Irritable Bowel Syndrome

Abstract

Introduction: Fecal microbiota transplantation (FMT) has garnered wide attention in both the popular media and medical community. To date, FMT has been shown to be an effective and acceptable treatment option for patients with recurrent C. difficile infection. Recent experience suggests that FMT may also play a role in treatment of diarrhea predominant irritable bowel syndrome (IBS-D). Among patients with IBS-D, the perception and acceptability of FMT and its various routes of administration have not yet been explored. Methods: We used a structured survey to elicit demographic information, interest in, and perspectives on FMT in patients who approached us for enrollment in an ongoing multicenter, randomized, doubleblinded, placebo-controlled trial aimed to assess the efficacy of FMT for the treatment of IBS-D. Results: Forty-one patients (25 who enrolled in, 6 who were excluded from, and 10 who declined participation in the trial) completed our survey. All subjects were recruited after they approached the research team with an interest in participating in the trial. Mean participant age was 38.6±12.7 yrs. Subjects were predominantly white (n=33, 80%) men (n=25, 61%) who had achieved higher-level education (n=32, 78%). Many (n=19, 46%) were employed in health, science, education, or technology fields. Participants' first exposure to FMT was commonly from Internet media (n=14, 34%). Participants were unsure if FMT would work, but searching for alternative options to treat their IBS-D (n=24, 59%). Most considered FMT to be a “natural” treatment (n=35, 85%). All 41 individuals were willing to undergo FMT by capsule or colonoscopy. Most were willing to undergo FMT by EGD (n=40, 98%), enema (n=39, 95%), nasogastric tube (n=36, 88%), or oral suspension (n=29, 71%). More participants rated FMT by capsules as a perfectly acceptable option (n=31, 76%) than they did FMT by colonoscopy (n=19, 46%), enema (n=16, 39%), or EGD (n=16, 39%). None rated FMT capsules as an unacceptable option. The main concern regarding FMT, seen in 15 patients (37%), was the potential of experiencing an adverse effect. Conclusion: Individuals with IBS-D who want to undergo FMT are cautiously optimistic that FMT will help them, and concerned mainly about the potential risks. Patients with IBS-D who seek out FMT may differ substantially from the larger IBS-D population. Overall, FMT capsules are more highly preferred than any other FMT administration route.