AGA guideline endorses FMT for recurrent C. difficile; ‘not yet advised’ for IBS, IBD
Click Here to Manage Email Alerts
Key takeaways:
- Fecal microbiota-based therapies are effective in preventing recurrent Clostridioides difficile infection in select patients.
- FMT is not yet recommended for other conditions like IBD, pouchitis or IBS.
Although effective in select patients, the AGA advised against fecal microbiota-based therapies to prevent recurrent Clostridioides difficile infection in severely immunocompromised adults or to treat other gastrointestinal conditions.
“Under each indication we have included expert recommendations to help those who want to implement FMT understand best practices,” Colleen R. Kelly, MD, from Brigham and Women’s Hospital and Harvard Medical School, said in a media briefing. “As simple as it sounds — put dilute stool into a person — there are a lot of questions around making the diagnosis of recurrent CDI, what to do with anti-CDI therapies around FMT, how protocols differ for treatment of recurrent vs. acute severe/fulminant CDI and how to decide when to use an alternative therapy instead.”
“Also, when patients inquire about use in IBS and IBD they can refer to these guidelines and explain it is not yet advised,” Kelly added.
Using the evidence-to-decision framework, AGA panelists developed clinical recommendations for use of FMT in adults with recurrent C. difficile infection (CDI), conventional FMT for severe to fulminant infection in a hospital setting, and use of FMT for inflammatory bowel diseases and irritable bowel syndrome, as well as considerations for implementation in practice.
Highlights of the seven recommendations, which were published in Gastroenterology, include:
- Select use of FMT is suggested for immunocompetent adults with recurrent CDI following completion of standard-of-care antibiotics.
- Select use of conventional FMT is suggested for mildly or moderately immunocompromised adults with recurrent CDI following standard-of-care antibiotics.
- The AGA suggests against use of FMT after standard-of-care antibiotics for severely immunocompromised adults with recurrent CDI.
- Select use of conventional FMT as adjuvant treatment is suggested for adults hospitalized with severe or fulminant CDI who do not respond to antimicrobial therapy.
- Conventional FMT as treatment for IBD, pouchitis and IBS should only be considered in the context of clinical trials.
“There is potential use for FMT in IBD, specifically ulcerative colitis, but where to position the treatment is unclear,” Osama Altayar, MD, from Washington University School of Medicine, said in the media briefing. “There is also potential for use in IBS but which population may benefit from it is still unclear. We gave future directions in our guideline on what we need to advance the field to implement those treatments.”
The AGA will update this guideline in 3 to 5 years when new data becomes available.
Collapse
Click Here to Manage Email Alerts