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Fecal microbiota transplantation: facts and controversies

van Nood, Elsa; Speelman, Petera; Nieuwdorp, Maxa; Keller, Josbertb

Current Opinion in Gastroenterology: January 2014 - Volume 30 - Issue 1 - p 34–39
doi: 10.1097/MOG.0000000000000024

Purpose of review To review the current evidence on fecal microbiota transplantations (FMTs) for recurrent Clostridium difficile infections (CDIs), metabolic syndrome and inflammatory bowel disease.

Recent findings 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.

Summary 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

Correspondence to Els van Nood, AMC-UvA, Department of Internal Medicine, Meibergdreef 9, Room F4-222, 1105 AZ Amsterdam, the Netherlands. Tel: +31 20 5669111; fax: +31 20 5669343; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins