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Fecal Microbiota Transplantation for the Treatment of Clostridium difficile Infection: A Systematic Review

Cammarota, Giovanni MD; Ianiro, Gianluca MD; Gasbarrini, Antonio MD

Journal of Clinical Gastroenterology: September 2014 - Volume 48 - Issue 8 - p 693–702
doi: 10.1097/MCG.0000000000000046
ALIMENTARY TRACT: Original Articles

Goal: By systematic review, we assessed the impact of fecal microbiota transplantation (FMT) for the treatment of Clostridium difficile (CD)-associated diarrhea.

Background: Fecal microbiota microbiota transplantation from a healthy donor into an individual with CD infection (CDI) can resolve symptoms.

Study: We conducted systematic searches in PubMed, SCOPUS, Web of Science, and Cochrane Library. The last search was run on February 8, 2013. The following Medical Subject Headings terms and keywords were used alone or in combination: Clostridium difficile; Clostridium infection; pseudomembranous colitis; feces; stools; fecal suspension; fecal transplantation; fecal transfer; fecal infusion; microbiota; bacteriotherapy; enema; nasogastric tube; colonoscopy; gastroscopy; fecal donation; donor. A critical appraisal of the clinical research evidence on the effectiveness and safety of FMT for the treatment of patients with CD-associated diarrhea was made.

Results: Twenty full-text case series, 15 case reports, and 1 randomized controlled study were included for the final analysis. Almost all patients treated with donors’ fecal infusion experienced recurrent episodes of CD-associated diarrhea despite standard antibiotic treatment. Of a total of 536 patients treated, 467 (87%) experienced resolution of diarrhea. Diarrhea resolution rates varied according to the site of infusion: 81% in the stomach; 86% in the duodenum/jejunum; 93% in the cecum/ascending colon; and 84% in the distal colon. No severe adverse events were reported with the procedure.

Conclusions: FMT seems efficacious and safe for the treatment of recurrent CDI. Hospitals should encourage the development of fecal transplantation programs to improve therapy of local patients.

Department of Internal Medicine, Division of Internal Medicine and Gastroenterology, A. Gemelly University Hospital, Rome, Italy

The authors declare that they have nothing to disclose.

Reprints: Giovanni Cammarota, MD, Department of Internal Medicine, Division of Internal Medicine and Gastroenterology, A. Gemelli University Hospital, Largo A. Gemelli 8, 00168 Rome, Italy (e-mail:

Received May 8, 2013

Accepted October 19, 2013

© 2014 by Lippincott Williams & Wilkins