More Advocacy Needed for FMT as an IBD Treatment

While more and more research shows the value of fecal microbiota transplantation (FMT) as a treatment for recurrent clostridium difficile infections (CDI), awareness and knowledge is still lacking for the efficacy and safety of the treatment for patients with inflammatory bowel disease (IBD).

A team, led by Yanghua Liu, Department of Nursing, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, ChinaFaculty of Health, Education and Life Sciences, Birmingham City University, examined recent studies on healthcare provider knowledge and confidence in prescribing fecal microbiota transplantation as a viable treatment option for patients with IBD.

Fecal Microbiota Transplantation

Fecal microbiota transplantation is a relatively new treatment that involves taking feces from healthy donors to rebuild the gut microbiota of a diseased individual.

Recent research has pointed to fecal microbiota transplantation as a viable therapy option for patients with recurrent C difficile infections, but less so for primary CDI. However, while unclear, it is a promising therapy for IBD.

Currently, the National Institute for Health and Care Excellence (NICE) is soliciting healthcare provider advice on whether or not to update the guidelines on FMT use.

Surveys

The team identified primary studies from different databases with surveys of physicians, nurses, medical students, or associated health professionals.

The investigators identified 13 cross-sectional studies involving 4110 validated questionnaire responses.

Results

Nearly 40% (39.43%) of respondents were familiar with fecal microbiota transplantation (n = 3746; 95% CI, 37.87-41%).

Additionally, 58.81% of the respondents would recommend fecal microbiota transplantation to their patients (n = 1141; 95% CI, 55.95-61.67%) and 66.67% of the participants considered lack of clinical evidence as the greatest concern regarding the therapy (n = 1941; 95% CI, 64.57-68.77).

Finally, 40.43% of respondents would not implement FMT because of concerns about infection transmission (n = 1128; 95% CI, 37.57-43.29%).

“Healthcare providers’ knowledge of FMT is relatively low and education is an effective strategy to improve it,” the authors wrote. “As knowledge of FMT increases, willingness to recommend it also increases.”

Conclusions

A main takeaway from the study is that the overall level of healthcare providers’ knowledge of the therapy is still considered low. One way to improve this is to strengthen the professional training for fecal microbiota transplantation together with enhanced positive portrayal within mainstream media. Also educating medical students could be effective.

The investigators also suggested various ways to strengthen the public confidence in the therapy. These suggestions including strengthening fecal microbiota transplantation clinical efficacy and reducing infections.

They also said further research is needed to explore the donor screening procedures.

However, over time the readiness to recommend FMT has increased.

C difficile infections are more common for patients with IBD. This can lead to higher recurrence, worse disease progression, longer hospitalizations, diarrhea, and higher rates of colectomy and mortality.

The study, “Healthcare providers’ perception of fecal microbiota transplantation with clostridium difficile infection and inflammatory bowel disease: a quantitative systematic review,” was published online in Therapeutic Advances in Gastroenterology.