American Gastroenterological Association (AGA) Releases Guidelines on Fecal Microbiota Transplantation (FMT)

AGA Provides New FMT Guidelines for Recurrent C. difficile Infection

The American Gastroenterological Association (AGA) has developed clinical recommendations for the use of Fecal Microbiota Transplantation (FMT) in adults. This is particularly relevant for those struggling with recurrent C. difficile infection (CDI), severe to fulminant CDI, and inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS). These detailed guidelines are aimed at enabling rational and informed decision-making for patients and healthcare professionals alike.

The Role of FMT in Treating Recurrent CDI

Fecal Microbiota Transplantation (FMT) has been recognized as a safe and effective treatment option for most cases of recurrent CDI. The AGA endorses its use in adults but advises against its use in severely immunocompromised adults or for treating other gastrointestinal conditions. The guidelines also consider the treatment of recurrent vs. acute severe/fulminant CDI and highlight when to use alternative therapies.

The Potential Use of FMT in IBD and IBS

The guidelines underscore the potential of FMT use in IBD and IBS, but more research is needed to identify which specific populations may benefit from it. Its use for these conditions is currently not recommended outside the context of clinical trials. The guideline is set to be updated in the next 3 to 5 years as new data becomes available.

Emergence of Live Biotherapeutic Products (LBPs)

With nearly half a million people in the U.S. experiencing C. diff each year, new treatments are continually being explored. Live Biotherapeutic Products (LBPs) have emerged as promising treatments for preventing recurrent CDIs. The FDA has approved the first LBPs for this purpose, including FDA-approved therapies such as fecal microbiota live-jslm (REBYOTA) and fecal microbiota spores live-brpk (VOWST).

Future Directions for FMT Implementation

The guidelines also outline the future directions for advancing the field to implement FMT treatments. Expert recommendations from Dr. Colleen R. Kelly and Dr. Osama Altayar emphasize the need for clear protocols in diagnosing recurrent CDI. They also stress the importance of the use of anti-CDI therapies around FMT. The guidelines provide clear guidance for frontline clinicians on how to position FMT in the treatment of recurrent CDI and when to use it.

Final Note

While the AGA's new guidelines provide valuable insights and practical advice, the use of FMT remains a complex area with many unknowns. The guidelines aim to address uncertainties and hesitations, including concerns about infectious risk and limited experience with performing and administering FMT. The AGA encourages participation in clinical trials for patients interested in FMT or other fecal microbiota-based therapies for conditions other than C. diff.