Fecal microbiota transplantation (FMT)

At the IPPM Clinic, we offer fecal microbial transplantation (FMT) that meets world-class standards. With more than 10 years of experience in the field of digestive health, thoroughly screened local donors, flexible therapy options, experienced professional staff, and over 4000 successful FMT applications, these are just some of the reasons to undergo fecal transplantation at our clinic.

Fecal microbiota transplantation

What is fecal microbiota transplantation (FMT)?

Thanks to years of scientific research, we now know that the gut flora plays a key role in regulating many processes that take place in the human body, from digestion to immune system regulation. It’s therefore extremely important to maintain your gut flora in good shape through healthy lifestyle and proper nutrition. But what if the gut flora is severely damaged and conventional methods for its restoration are not helpful? In these kinds of cases, fecal microbial transplantation (FMT) becomes the main treatment of choice.

Faecal transplantation is the process of implanting gut microbiota obtained from a healthy donor into the patient's gastrointestinal tract. The result is the revitalization of the gut flora, an increase in bacterial diversity, and the restoration of optimal function of the intestinal system. Healthy gut microflora is acquired from the stool of donors and undergoes a special filtration process to remove waste components of the stool. The resulting material, free from digestive residues and other waste, can then be applied in rectal form and/or (after further processing) through oral capsules.

Existing research on gut microbiota and clinical uses of FMT

Over the past 20 years, clinical research has established connections between gut flora and a variety of diseases and health issues, with numerous studies supporting FMT therapy's effectiveness for many of these conditions.

Infections caused by Clostridium difficile or other pathogens

Clostridium difficile infections are caused by the overgrowth of this harmful bacteria in the digestive tract. Symptoms of the disease include severe diarrhea (sometimes containing blood), nausea, abdominal pain, vomiting and fever.

Intestinal infections caused by C. Diff. bacteria are often very resistant to antibiotics, and in some patients the infection can last for months despite antibiotic treatment. In such cases, fecal transplantation treatment is recommended. Clinical studies show that fecal transplantation can cure Clostridium difficile infections in more than 90% of cases.1 As a result, FMT is now indicated as the treatment of choice in patients with antibiotic-resistant recurring C. diff. infections.

FMT has also been successfully used to treat infections caused by other pathogenic bacteria. Singha et al. (2018) for example used FMT to treat gut infections caused by Enterobacteriaceae bacteria producing beta-lactamase (ESBL) – an enzyme that that blocks the effects of antibiotics. This makes these bacteria extremely resistant to antibiotic therapy. The results showed that after 2 FMT implants 40% of patients were completely cured of the infection.2

Inflammatory bowel disease (IBD) - Ulcerative colitis and Crohn's disease

IBD is a chronic, auto-immune inflammatory disease that affects the intestinal tract. Depending on where the inflammation is localized in the intestinal tract, the disease is split into ulcerative colitis or Crohn's disease.

Although the exact cause of this disease is not yet known, some studies have revealed a link between IBD and the gut flora. Specifically, they have shown that the diversity of the gut flora is generally reduced in patients with IBD. Conversely, an increase in the diversity of the intestinal microbiota in patients with IBD is associated with the onset of remission and a reduction in the severity of IBD symptoms.3

Since fecal transplantation is one of the most effective ways to increase the diversity of intestinal flora, its therapeutic use in the treatment of IBD has already been investigated by several studies and the research is ongoing.

To date, two large double-blind clinical trials investigated the use of FMT in dozens of patients with ulcerative colitis. The results of both trials have shown that the efficacy of this therapy in inducing and sustaining remission was many times higher in FMT patients than in the control group. 4,5

The same conclusion was reached by experts at Helen DeVos Children's Hospital in Michigan, who found that faecal transplants administered in the form of an enema were very effective and well tolerated in children, and helped to reduce the symptoms of ulcerative colitis.6

In Crohn's disease, a large, randomized clinical trial is still pending. However, several smaller studies have shown that FMT has the potential to help with this type of disease. For example, the results of a 2015 study (Zhang et.al) showed that 23 out of 30 (76.70%) patients with Crohn's disease achieved remission or reduction in symptoms after FMT treatment.7

Irritable Bowel Syndrome (IBS) and Chronic Constipation

Irritable bowel syndrome is a disease that affects 10-15% of the population.8 It’s the most widespread gastrointestinal disease characterized by unpleasant symptoms such as: bloating, abdominal pain, diarrhoea or constipation and flatulence. IBS is divided into different sub-types depending on whether the patient’s primary symptom is diarrhoea (IBS-D) or constipation (IBS-C), and some patients are known to move between the subtypes over time.

As with other gastrointestinal diseases (e.g. IBD), more and more research is starting to highlight the connection between this disease and the gut flora. IBS patients, for example, generally have lower gut microbiota diversity as well as reduced amounts of beneficial strains of bacteria such as Lactobacillus and Bifidobacteria.8

In view of these findings and due to the ability of FMT to restore the gut flora back to its optimal state, studies have examined the potential use of FMT as a novel form of IBS treatment.

A randomized clinical study from 2018 examined the efficacy of FMT in several dozen patients with IBS. The results were very positive - after 3 months of FMT treatment, 35 out of 55 patients reported a significant reduction in IBS related symptoms. This corresponds to a 65% success rate.9

A very high success rate has also been demonstrated in the treatment of patients with long-term constipation. In a different study, up to 90% of patients confirmed an immediate improvement in clinical symptoms after FMT therapy and the improvements persisted for several months after therapy in 60% of patients.10

Chronic fatigue syndrome (CFS)

Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a disease characterized by symptoms such as fatigue, lethargy, stress, sadness, loss of motivation and sleep disturbances. The exact cause of this disease has not yet been determined but it’s very likely that CFS is a multifactorial disease, meaning that its caused by multiple underlying factors.

We now have evidence that people suffering from chronic fatigue syndrome often show various changes in the composition of intestinal microbiota (dysbiosis), which may be one of the factors behind the development of CFS/ME.11 Patients with CFS/ME very often also suffer from irritable bowel syndrome (IBS), which is another good indication that the disease is strongly associated with the intestinal system.12

A 2012 study (Borody et al.) monitored the efficacy of FMT in 60 patients with chronic fatigue syndrome, with most patients also suffering from IBS. After receiving FMT treatment, improvements in CFS-related symptoms were observed in 70% of patients. Interestingly, 12 of these patients were contacted 15-20 years after the study and 7 of them reported that their CFS/ME symptoms never returned. The remaining 5 reported that although the disease did eventually return, they were symptom-free for several years after FMT treatment.13 Randomized, double-blind clinical trials investigating the efficacy of FMT in chronic fatigue syndrome are currently under way, and their results should be available in the coming years.

Non-gastrointestinal autoimmune conditions

Gastrointestinal micro-organisms provide their host with significant health benefits, one particular benefit being the regulation of the immune system (immune homeostasis). In addition, it has recently been shown that negative changes in the balance of intestinal microbial communities can cause immune system dysregulation, contributing to the development of autoimmune disorders.14 Currently, researchers are focusing on revealing ways in which intestinal microbiota interacts with the immune system and how these processes relate to autoimmune diseases.

We now know of several autoimmune diseases (other than IBD) in which the role of the gut flora has been confirmed. Examples include:

Hashimoto's syndrome15

Rheumatoid arthritis16

Type 1 diabetes17

Psoriasis18

Systemic lupus erythematosus19

 However, more research, specifically on the use of FMT in these conditions is needed to be able to determine whether FMT can actually help in these cases. Until then, the use of FMT in these conditions is strictly experimental, with no guaranteed outcome.

Neurological conditions

The gastrointestinal system and the brain constantly communicate through the peripheral nervous system, hormones and the immune system. Some bacteria found in the gut even produce neurotransmitters, just like our neurons. It has also been recently discovered, that the gut is able to communicate directly with the brain through the vagus nerve, which links the gut to the brain stem.20

Therefore, it’s no surprise that even in neurological diseases, associations between changes in the intestinal flora and symptoms of the disease have been found. For example, patients with Parkinson's disease show stereotypical quantitative and qualitative changes in their intestinal microbial composition compared to healthy people.21

The question remains what role these changes play in the course of the disease and whether they are the cause or only the consequence. In assessing the success of FMT therapy in neurological diseases, we are working with a very limited amount of existing clinical data. At the moment only case studies are available, with clinical trials still under preparation. For example, a clinical trial was announced in January 2019, which will examine the efficacy of FMT therapy in patients with Parkinson's disease.22

Worth mentioning is a case study focusing on three wheelchair-bound patients with multiple sclerosis in advanced stage of the disease. FMT was administered to all three patients mainly in the hopes of helping to reduce the chronic constipation that they were all suffering from. The results however were very surprising. FMT didn’t just eliminate their constipation, but also dramatically improved the neurological condition of all three patients. Two of the three patients were able to stand up and walk again after FMT.23

Although the results of the above-mentioned case study are very positive, it should be emphasized that this is not a clinical study and the number of participants was very small. Large scale clinical research is needed to confirm the findings before drawing any conclusions. Currently, the use of FMT therapy in neurological diseases falls under ​​experimental supportive therapy. FMT is absolutely not a substitute for prescribed treatment, nor is it a cure.

Autism spectrum disorders

Autism Spectrum Disorder (ASD) is a group of brain development disorders defined by stereotypical behavior with communication and social interaction deficiencies. In 2012, the incidence of this disorder was estimated at 14.6 per 1000 children aged 4.24

To date, the exact causes of ASD haven’t been fully understood and the available treatment methods are very limited. Previous studies focused in particular on investigating the role of genetic causes, immune system dysregulation, inflammation, the impact of toxic substances and intestinal microbiota.

Clinical findings indicate that gastrointestinal symptoms such as abdominal pain, flatulence, diarrhoea or constipation occur in patients with ASD much more frequently than in the rest of the population. Additionally, it was found that children with ASD who also suffer from gastrointestinal problems score worse when it comes to typical ASD symptoms such as mood swings, hyperactivity, and socialization/communication deficiencies.25,26 Therefore, the treatment of GI symptoms in children with ASD is receiving ever more attention.

Several clinical studies have demonstrated that the composition of intestinal flora in autistic patients differs significantly compared to healthy populations. For example it been found that patients with ASD suffering from constipation have an increased presence of particular strains of bacteria such as Escherichia / Shigella and Clostridium in the gut. On the contrary, other bacterial strains are often under-represented.27

Currently, research is focusing on the use of FMT in the treatment of ASD based on the assumption that FMT can normalize intestinal microbiota in these patients and reduce GI symptoms.28

A recent clinical trial conducted in 2017 confirmed this hypothesis in practice. FMT therapy was administered to 18 children with ASD aged 7 to 16 years. All children also suffered from gastrointestinal symptoms. The results of the study showed that after treatment, gastrointestinal symptoms such as constipation, diarrhoea and abdominal pain were reduced on average by 80%. More surprising, however, was the finding that there was a significant reduction in ASD-related symptoms in children after FMT, such as moodiness, hyperactivity, lethargy, stereotypical behaviour, and speech/communication problems. As a result, the mean development age (measured on the VABS-II clinical scale) in these children increased by 1.4 years after FMT and these positive changes persisted even 2 months after treatment.28

Despite the very positive results of this pilot study, it is worth mentioning that the use of FMT therapy in children with ASD is a completely new concept and falls under experimental treatment. Other clinical trials are necessary to confirm the efficacy of FMT in ASD patients, particularly in children without digestive problems.

Liver and Bile duct (cholangitis) diseases

Fecal transplantation has recently been experimentally used to treat bile duct inflammation (cholangitis) with positive results. A small 2017 pilot study examined the efficacy of FMT in 6 patients with chronic cholangitis. Three out of 6 patients experienced a 50% reduction in blood ALP levels after administration, indicating an improvement in liver function. This was accompanied by changes in the composition of patients' gut flora and increased microbiome diversity.29

The use of FMT for other liver diseases is currently the subject of experimental investigation. A different 2017 study describes the experimental use of FMT in the treatment of patients with cirrhosis of the liver and hepatic encephalopathy. The outcome was "reduced hospitalizations, improved cognition, and dysbiosis in [patients with] cirrhosis with recurrent HE".30 Another clinical trial investigating the use of FMT in cirrhosis of the liver is currently underway.31

Obesity, diabetes and metabolic syndrome

The development and radical increase in obesity and metabolic syndrome are associated with genetic predispositions and environmental factors. A large number of clinical studies have confirmed that intestinal microbiota plays an important role in the development of obesity and associated symptoms such as metabolic syndrome and diabetes. It has also been found that lean and obese individuals show differences in the composition of their gut flora.32,33

Therefore, FMT is being explored as a novel form of treatment for these diseases. A study from 2017 examined the efficacy of FMT in patients with metabolic syndrome. The results showed that following the transplantation of microbiota from healthy, lean donors, approximately half of the patients experienced an improvement in their condition.34

Currently, a clinical trial examining the efficacy of FMT therapy in obesity is underway. Results are expected at the end of 2019.35

Allergies and Intolerances

According to a report by Mazzocchi et. al (2017), bacteria which naturally inhabit our digestive tract play a role in preventing allergies and at the same time may help in their treatment and elimination. An important role of intestinal bacteria is their involvement in the activation of the mucosal immune system to prevent the passage of allergens directly into the bloodstream.36 The use of FMT in treatment of allergies is currently the subject of research. For example, a clinical trial is currently underway in the US to test the efficacy of FMT in treating people with severe peanut allergy.37

Other conditions

Please note that the above is not a complete list of conditions for which FMT has been or could be used for. New findings about FMT and the role of microbiota in various diseases are being published constantly. We strongly recommend that all of our patients do their own research on FMT and their condition to decide whether the treatment is right for them. Additionally, if you're not sure whether FMT could be useful in your specific case, please feel free to contact us and we will be happy to give you our advice.

FMT treatment at IPPM Clinic

The IPPM clinic was established 10 years ago, and we have been providing FMT therapy for more than 7 years to date. During this time, we have administered more than 4000 rectal FMT transplants to more than 600 patients. Thus, the IPPM Clinic can rightly be considered one of the leading FMT clinics not only in Europe but also in the world.

At IPPM Clinic, we believe that every patient is unique and requires a unique approach. Therefore, unlike most other FMT clinics, we offer several different FMT treatment options, tailoring the choice of treatment to the diagnosis, medical history, and needs of each individual patient.

In addition to the more "traditional" rectal FMT treatment, IPPM Clinic also offers an innovative form of FMT in the form of oral capsules, as well as a combined rectal and oral FMT treatment to provide the best of both approaches. This allows us to target the treatment not only at the large intestine, as is the case with traditional rectal-only FMT treatment, but also the small intestine, which is also home to a large number of important, probiotic bacteria.

Rectal FMT treatment

For patients suffering from diseases primarily affecting the colon, we provide rectal FMT treatment administered through a rectal catheter. This is a quick and completely safe and painless procedure that does not require any form of sedation, even in children.

Number of applications: 5 - 10 rectal applications
Duration: 5 - 10 days at the clinic
Oral FMT treatment

For patients suffering from conditions primarily affecting the small intestine, we provide FMT treatment in the form of oral FMT capsules. Specialized capsules are used that ensure that the capsule only dissolves once it reaches the small intestine, thus protecting its contents against stomach acids.

Number of applications: 30 to 60 oral capsules
Duration: 30-60 days at home
Combined FMT treatment

For patients who need to revitalize the intestinal flora not only in the large but also in the small intestine, we offer a comprehensive, combined therapy consisting of rectal FMT applications + oral FMT capsules.

Number of applications: 5 rectal applications + 30 to 60 oral capsules
Duration: 5 days in the clinic + 30-60 days at home
4000+ FMT applications
600+ FMT patients
10 years of experience

Our donors

The safety and quality of our rectal FMT implants and oral FMT capsules is of utmost importance to us at IPPM Clinic. We therefore based our donor selection and stool testing protocols on the latest guidelines and recommendations from experts and relevant medical organizations. Our donors must meet strict criteria such as:

  • young age (under 30 years old)
  • normal body mass index (BMI)
  • a healthy and varied diet
  • an active lifestyle
  • no use of antibiotics or other medications*
  • no smoking

Optimal health, both physically and mentally, is a given for our donors. They must also possess a diverse yet balanced composition of gut flora, ensuring that their stool is of suitable quality for the purposes of FMT treatment. The donors are Slovak citizens living near the laboratory, which is essential in order for the stool to be processed as quickly as possible.

*On request we can provide material only from donors who have not been vaccinated against Covid-19.

Testing

At IPPM, we don’t leave anything to chance when it comes to patient safety. That's why we test our donors more frequently and more thoroughly than most competing FMT providers. Each donor undergoes regular blood tests at least twice a month to rule out a wide range of infectious diseases such as HIV, hepatitis, syphilis and others.

We also test every single donated stool to rule out the presence of pathogenic bacteria, viruses and parasites, including dangerous species of antibiotic-resistant bacteria. Donors also undergo a weekly PCR test to rule out covid-19.

Therefore, we are not afraid to say that our FMT implants and oral capsules are among the safest in the world.

Rectal FMT implants

Once tested, stool undergoes a multi-stage filtration process during which the waste components of the stool are eliminated. Left behind is a highly concentrated liquid suspension containing the complete intestinal microflora of the donor without waste components such as dead cells, food residues, mucus etc. This liquid suspension is then separated into individual batches and deep frozen in medical freezers for future use for rectal FMT applications.

Oral FMT capsules

Our oral FMT capsules are based on our rectal FMT implants, which are gently stripped of water by a freeze-drying process called lyophylization. This is a process that is used, among other things, in the production of probiotics, since unlike other drying methods, freeze-drying does not lead to the mass death of bacteria.

The result is a powder containing the complete intestinal flora of the donor, which is then divided into individual doses into special gastro-resistant capsules, which are designed to dissolve only once they reach the small intestine. This ensures the bacteria can safely pass through the harsh stomach environment without being destroyed by stomach acids.

Why undergo FMT therapy at the IPPM clinic?

Experience

At IPPM we have been providing FMT treatment for more than 7 years. During this time, we have administered FMT to hundreds of patients of all ages.

Safety

Our donors are thoroughly and regularly tested for a wide range of diseases. Every single donated stool is also tested to rule out the presence of pathogens and parasites.

Flexibility

We can offer our patients a variety of FMT treatment options depending on their specific health problems and individual requirements. Our waiting times are minimal.

Expertise

Our team is made up of experienced doctors and nurses with years of experience in the field of digestive health and FMT treatment.

Convenience

Do not burden yourself with the organization of accommodation and transfers. At IPPM, we are happy to assist you in arranging accommodation directly next to the clinic, as well as providing transportation to and from the airport. 

How does the process work?

Accommodation and transportation

At IPPM, it is important to us that our patients feel comfortable during their stay here and that they avoid unnecessary stress.

If you are coming from abroad, we can arrange accommodation for you in a pleasant environment right next to the clinic, either in modern hotel rooms or in private apartments each featuring their own kitchen.

If necessary, we will also be happy to arrange an airport transfer for you, for example from the Vienna airport or Bratislava airport.

A complete up-to-date accommodation and transportation price list is available on request.

What happens after FMT treatment?

Although FMT is a major step towards a regaining a healthy digestive system, we only see it as one piece of the puzzle. At IPPM we focus on a providing a comprehensive treatment protocol that aims to optimize intestinal microbiota, to revitalize the intestinal mucosa as well as to offer lifestyle recommendations. During your stay at the clinic, we will give you advice on how to take good care of your new gut microbiota even after returning home to ensure that you’re able to maintain the benefits of FMT treatment long-term.

How to proceed in case of interest?

If you're interested in undergoing FMT treatment at our clinic please contact us by filling out the contact form on this page. Please make sure to include your full name, correct email address and phone number (including country dialling code) and a brief description of your medical problems. We will then contact you via the email address that you provided and send you more information about the treatment process. We also offer free initial consultation via Zoom, Skype, WhatsApp or over the phone for all prospective FMT patients.

Frequently Asked Questions

What is the cost of FMT treatment?

It’s not possible to publish the price of FMT treatment on our website because at IPPM we offer several variants of the therapy, and the final price depends on the method of application and the number of rectal implants / oral capsules administered. The ideal combination for a given patient is set individually based on the diagnosis and individual needs. Therefore, please contact us via the contact form for more information on pricing.

Is it possible to guarantee that FMT treatment will definitely help me?

It’s very important to emphasize that very few medications or medical treatments have a 100% success rate. Although FMT treatment has been shown to be very effective for some diseases (e.g. 93% success rate in the treatment of c. difficile infections), for other diseases the success rate is significantly lower. In addition, it’s important to note that although the gut flora plays a crucial role in a person's overall health and can influence a wide range of diseases, it’s not the only factor. Therefore, if the primary cause of your disease is not related to your gut flora, restoring your gut flora through FMT treatment may not have a positive effect on your condition. Finally, just as some medications work for some patients but not for others, the response to FMT treatment can also be very individual. Some patients experience significant improvements shortly after FMT treatment, while other patients may experience a more modest improvement in their condition or they may have to wait longer before experiencing the benefits. Therefore, we cannot 100% guarantee that the treatment will help every single patient.

Do you provide FMT treatment for conditions other than clostridium difficile gut infections?

Yes, at our clinic we offer FMT therapy to patients for other diseases as well, not only for c. difficile infections. Clinical research over the past decades has shown that FMT treatment can also be beneficial for patients suffering from a variety of other diseases, including conditions such as irritable bowel syndrome (IBS), ulcerative colitis, chronic fatigue syndrome (CFS), etc. Please contact us via the contact form and we will be happy to discuss the suitability of FMT treatment in your case.

How do you administer FMT treatment at IPPM Clinic?

At the IPPM clinic we offer two options. We offer rectal FMT treatment, which is administered quickly and painlessly via a rectal catheter with no sedation required. We also offer oral FMT treatment in the form of oral FMT capsules. Finally, we also offer combination treatment where we first perform rectal FMT applications at the clinic and then the patient continues to take oral FMT capsules at home. We will recommend the best treatment option for you based on your diagnosis and individual needs.

Where do the FMT implants and FMT capsules you provide in your clinic come from?

At IPPM, we have established our own donor network and donor bank. Unlike some other clinics and FMT providers who purchase material from foreign suppliers, at IPPM we have full control over the selection of our donors and the quality of our rectal FMT implants / oral FMT capsules. All of our donors are Slovak citizens, live close to the clinic and we know them all personally. All donor testing and stool processing is provided by a professional, fully certified medical laboratory.

What criteria do the donors need to meet?

We have only a few carefully selected donors with whom we work on a long-term basis. All donors must be young (under 30 years of age) and active, have a healthy lifestyle, a healthy and balanced diet and an ideal BMI (body mass index). Of course, donors must be 100% healthy, with no medical conditions or family history of any serious illnesses. Donors must not take any medication, must not smoke and must meet a number of other criteria that affect the quality of their microbiome, such as lack of antibiotic use. All donors undergo microbiome analysis to confirm that they have a balanced and diverse gut flora ideal for the needs of FMT treatment.

How do you test donors and their stool to make sure it’s 100% safe?

At IPPM, we take the safety of our patients very seriously. We have a robust screening protocol that includes testing every single donated stool for a wide range of pathogens and parasites, including antibiotic-resistant bacteria. All donors must also undergo blood tests every 2 weeks to rule out a wide range of infectious diseases. We also test our donors weekly with PCR tests to rule out covid-19. All tests are performed by a professional, certified medical laboratory. The safety of our implants and oral capsules is verified by years of practice - we have administered FMT treatment to hundreds of patients without a single case of pathogen/parasite transmission or serious side effects.

Are the donors vaccinated against covid-19?

We know that some patients may be hesitant about receiving material prepared from the stool of donors who have been vaccinated against covid-19. Although there is no evidence indicating that people who have been vaccinated against covid-19 are less suitable as stool donors, on request we are able to provide material prepared only from the stool of donors who have not been vaccinated against covid-19.

What are the possible risks and side effects of FMT treatment?

Side effects of FMT treatment are generally very mild and occur in only a small percentage of patients. Some patients may experience mild gastrointestinal upset at the beginning of treatment, but this usually lasts only one or two days. As far as risks are concerned, all medical interventions involve some risks, and faecal transplantation is no exception. However, in general FMT treatment is considered to be a low-risk medical procedure. The main risk associated with FMT treatment, which is the possibility of transmitting pathogens or parasites from donor to the patient, can be almost completely eliminated by thorough and comprehensive testing of donors and all donated stool. At IPPM Clinic, we are proud to provide some of the safest rectal FMT implants and oral FMT capsules in the world, having administered FMT treatment to hundreds of patients over the past 7 years without a single case of serious side effects or the transmission of a pathogen/parasite/disease.

How long does the treatment take?

Generally, treatment at the clinic takes 5 or 10 working days depending on the number of FMT rectal implants administered. Depending on the chosen treatment course, you may then need to continue taking oral FMT capsules at home for 4-8 weeks.

Do you also administer FMT treatment to children at your clinic?

Yes, we also treat children at the IPPM clinic. We are one of the most experienced FMT clinics in the world when it comes to the application of FMT treatment in children having treated hundreds of children of all ages.

Is it necessary to repeat the treatment in the future?

In most cases, a single course of FMT treatment is all it takes to achieve a long-term improvement. More than 90% of our patients have undergone FMT therapy only once. However, some patients may need to repeat the treatment at some point in the future for best results or to maintain the benefits in the long term.

How long after FMT treatment can I expect to see results?

This is very individual. In general, however, FMT treatment does not lead to overnight results. The newly implanted gut flora needs time to fully integrate into the existing microbiome and for complete colonization of the entire gut to occur. In some patients, the first results/improvements are already visible within the first weeks after therapy, while in others the improvements occur more slowly, gradually over several months.

Is rectal FMT painful? Is sedation/anaesthesia necessary?

Not at all. At IPPM, we use a completely painless and highly safe method of administering rectal FMT implants using a rectal catheter. This is a thin, flexible plastic tube that is inserted through the rectum into the colon. Through this thin tube, liquid material containing the complete intestinal flora of the donor is then injected into the colon. It’s very similar to having an enema performed. The application process itself takes only a few minutes and no sedation or anaesthesia is required. Even children can handle the application very well. In addition to rectal application, we also offer oral FMT capsules as a completely non-invasive treatment option.

Is a special diet required before, during or after FMT therapy?

No, you do not need to follow any special diet before, during or after treatment. However, you will need to avoid eating food for one day before we start treatment (see the answer to question 20 for more information).

Will my medical insurance provider reimburse me for FMT treatment if I have it at performed at IPPM Clinic?

We only have had a handful of patients over the years who were able to get the treatment covered by their medical insurance, however these patients all had premium private medical insurance. In most cases, medical insurance will not cover the cost of FMT treatment especially for medical conditions other than clostridium difficile infections.

Do you have one or more donors?

At our clinic we administer material from several donors during the course of treatment to achieve a higher diversity of intestinal flora at the end of the treatment. However, each individual rectal implant and each individual oral capsule contains material obtained from the stool of only one donor.

Do you recommend any nutritional supplements before/during/after FMT therapy?

Yes, we recommend that our patients take several nutritional supplements after FMT treatment. We have selected these supplements specifically with the aim of helping to support your new gut flora.

How long are the waiting times when arranging FMT treatment?

We pride ourselves on being very flexible and having minimal waiting times. Waiting times at our clinic very rarely exceed 2 weeks. However, if you wish to use our accommodation services, we recommend that you book your treatment preferably a few weeks in advance so that we can guarantee that we will be able to provide accommodation for you during your chosen treatment date.

How do I prepare for FMT treatment?

Pre-treatment preparation begins 1 day before the first rectal FMT application. Adult patients will need to fast from noon until the following morning. Children can continue to consume liquid-based foods. You will also need to take laxatives on this day, which we will provide free of charge as part of the treatment. The aim of the preparation is to remove all stool from the intestinal tract, which will make it easier for the liquid material to reach the higher parts of the colon. For patients who undergo FMT treatment in the form of oral capsules only (without any rectal application), this preparation process is not needed.

Bibliography

  1. Gough, E., Shaikh, H. and Manges, A. (2011). Systematic Review of Intestinal Microbiota Transplantation (Fecal Bacteriotherapy) for Recurrent Clostridium difficile Infection. Clinical Infectious Diseases, [online] 53(10), pp.994-1002. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22002980.
  2. Singh, R., de Groot, P., Geerlings, S., Hodiamont, C., Belzer, C., Berge, I., de Vos, W., Bemelman, F. and Nieuwdorp, M. (2018). Fecal microbiota transplantation against intestinal colonization by extended spectrum beta-lactamase producing Enterobacteriaceae: a proof of principle study. BMC Research Notes, [online] 11(1). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863815/.
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