AGA guideline endorses fecal microbiota transplant as treatment for recurrent C. diff infection

American Gastroenterological AssociationFeb 21 2024

In the first comprehensive evidence-based guideline on the use of fecal microbiota-based therapies for gastrointestinal disease, the American Gastroenterological Association recommends fecal microbiota transplant (FMT) for most patients with recurrent Clostridioides difficile (C. diff) infection. 

Using fecal microbiota transplant, we take stool from a healthy donor and transfer it to the colon of the person with recurrent C. diff, restoring balance to their gut microbiome. FMT is a safe and effective treatment with enough scientific evidence to offered to most patients with two or more C. diff recurrences." 

Anne Peery, guideline author 

In the U.S., nearly half a million people each year experience C. diff. One in six of those people will deal with a C. diff recurrence within two to eight weeks. 

For patients with recurrent C. diff infection at a high risk of recurrence: 

• AGA recommends the use of FMT-based therapy after completing a course of standard-of-care antibiotics. Only severely immunocompromised patients (such as patients who are neutropenic or have received a bone marrow transplant) are excluded from this recommendation. 

For hospitalized patients with severe C. diff infection: 

• AGA recommends the use of conventional FMT following standard of care antibiotic therapy in select patients if there is no improvement. 

FMT therapies are not recommended as a treatment for inflammatory bowel diseases (IBD) or irritable bowel syndrome (IBS). AGA encourages patients interested in FMT for conditions other than C. diff to participate in a clinical trial. 

Key takeaways 

• FMT offers hope to patients suffering from recurrent C. diff infection, as a safe and effective treatment. 

• The majority of patients with recurrent C. diff are candidates and can consider an FMT therapy to prevent recurrence. 

"C. diff is debilitating. Thanks to this new American Gastroenterological Association guideline, patients will suffer for shorter periods of time and be able to get back to leading happy and healthy lives," concluded Amanda Kabage, MS, FMT researcher and FMT recipient who contributed to the development of this guideline. 

This guideline covers the use of conventional FMT, performed most commonly using donor stool delivered via colonoscopy, as well as recently FDA-approved therapies such as fecal microbiota live-jslm (REBYOTA) delivered via enema and fecal microbiota spores live-brpk (VOWST) delivered in an oral capsule.