Fecal microbiota transplant (FMT) is pretty much what it sounds like: taking stool (poop) from one person and putting it into another person’s colon. It is an idea that has been under study for use in inflammatory bowel disease (IBD), and ulcerative colitis especially, for many years.
Editor’s note: Fecal microbiota transplant is only FDA-approved for use as a treatment for infection with Clostridium difficile that doesn’t respond to other medications. Experts recommend against its use outside of a clinical trial for any other condition, including self-administered fecal transplants.
The history of trying to get the bacteria from one person’s colon into another person goes back centuries, however. A Chinese scientist named Ge Hong used what was called “yellow soup” to help treat diarrhea. In the 4th century this would have been done via what we might today call a fecal-oral route. (Stripling)
It’s unknown how many people decided to live with the diarrhea instead of drinking the soup. Thanks for the offer, though.
Today there are techniques to get the bacteria from one place to another without any “soup.” This can include freeze dried pills, colonoscopy, NG tube, or enema, among others. There are FMT products that are approved for use in treating a serious infection of the colon by a bacteria called Clostridium difficile. (FDA)
But in the United States, it’s not yet approved for treating any form of IBD, although it may be used in clinical trials.
However: not being approved doesn’t mean it’s not being used behind closed doors.
Expanding Public Understanding of FMT
FMT is not yet well known by the public (neither is IBD, for that matter). That’s why I was interested to hear of the documentary film, Designer $hit, which delves into FMT for use in treating ulcerative colitis.
The film contains the story of Saffron Cassaday, an award-willing filmmaker from Los Angeles. Cassaday was struggling to manage her ulcerative colitis and looking for something — anything — that might help address her symptoms. So began her journey in learning more about the microbiome, how it might be important in the development and the treatment of IBD, and how FMT could mean big business…for someone.
Designer $hit is both an intimate journey of what it’s like to live with the effects of ulcerative colitis and the story of FMT as a theoretical treatment for IBD and for other conditions outside the digestive system.
Cassaday puts her own microbiome, her health, and her relationship on the line to explore the edges of the theoretical connection between FMT and ulcerative colitis. Along the way, Designer $hit educates about the microbiome, IBD, and the science and the art behind fecal transplants.
The Importance of $hit
The film has the potential to raise awareness of IBD, the difficulties it poses for patients, and the challenges of current treatments. It also increases the visibility of FMT, which may be thought of as distasteful by the general public who may not have a clear idea of how it’s used.
People with IBD might think differently, however. One 2013 study of people with ulcerative colitis showed that a majority of those with mild or moderate disease would consider FMT. For severe disease: 100% said they would try it. This speaks to the devastating effects of IBD and the importance patients place on managing their disease. (Kahn)
After all, when it compares to stopping the sometimes debilitating symptoms of IBD: what’s a little more poop?
But — Don’t Try This At Home, Kids
FMT in clinical trials is usually considered safe. There can be adverse events, but most are short-term. However, even in controlled situations, there have been harms. (Park)
In 2020, transplants that were done under controlled conditions may have resulted in infection. It’s thought that FMT spread enteropathogenic Escherichia coli (EPEC) and Shigatoxin-producing Escherichia coli (STEC) to some immunocompromised patients that were in a clinical trial. (FDA, 2020)
Some of the long-term adverse effects reported after FMT in trials include obesity and immune-mediated conditions (including rheumatoid arthritis and IBD). Again, FMT is thought to have a good safety record, but that’s only known (Park)
This is after the donors and the stool has been through a rigorous testing and production process. Without processing and testing, there would be no way to tell if any harmful bacteria is being transferred.
Where We End Up
It’s not known yet if FMT is going to be a good option for treating IBD. Or an option for a certain percentage of people with IBD. Or for preventing IBD. We just don’t know. So far, trials of FMT in IBD have been disappointing.
More needs to be understood about why FMT might work, how to get the “right” stool for the right person, and how to avoid the potential for harms. If and when researchers get it right, it could open up a host of new treatments for all kinds of disorders.
If it’s known what “type” of microbiome is best for a particular person, maybe their body could be coaxed into maintaining it. It’s incredibly exciting. It’s just not ready for widespread use yet.
Art is meant to push boundaries, which includes film. It’s important to remember that Designer $hit is meant to test those boundaries and encourage the more widespread understanding of IBD, FMT, and the microbiome.
The filmmakers opened the bathroom door on FMT. Now: what happens next?
Designer $hit: A Microbiome Love Story is available to pre-buy prior to its release on streaming November 14th. Private screenings for community organizations can be requested by contacting the filmmakers. Everyone is welcome to attend viewings and panels starting on November 8th with the Designer $hit team, scientists, gastroenterologists, and patients.
View the trailer: https://www.designershitdocumentary.com/about-the-film
Buy the film: https://cyberseniors.vhx.tv/checkout/designer-hit/purchase
Book a screening: https://www.designershitdocumentary.com/book-a-screening
Attend viewings and panels: https://watch.eventive.org/designershit
Stripling J, Rodriguez M. Current Evidence in Delivery and Therapeutic Uses of Fecal Microbiota Transplantation in Human Diseases-Clostridium difficile Disease and Beyond. Am J Med Sci. 2018;356(5):424-432. doi:10.1016/j.amjms.2018.08.010
U.S. Food and Drug Administration. Fecal Microbiota Products. Updated April 28, 2023. Accessed October 3, 2023. https://www.fda.gov/vaccines-blood-biologics/fecal-microbiota-products
Kahn SA, Vachon A, Rodriquez D, et al. Patient perceptions of fecal microbiota transplantation for ulcerative colitis. Inflamm Bowel Dis. 2013;19(7):1506-1513. doi:10.1097/MIB.0b013e318281f520
U.S. Food and Drug Administration. Fecal Microbiota for Transplantation: Safety Alert – Risk of Serious Adverse Events Likely Due to Transmission of Pathogenic Organisms. Updated April 7, 2020. Accessed October 10, 2023. https://www.fda.gov/safety/medical-product-safety-information/fecal-microbiota-transplantation-safety-alert-risk-serious-adverse-events-likely-due-transmission
Park SY, Seo GS. Fecal Microbiota Transplantation: Is It Safe?. Clin Endosc. 2021;54(2):157-160. doi:10.5946/ce.2021.072