History of FMT
Fecal transplantation dates back to 4th century China, where human fecal suspension by mouth was used to cure food poisoning and severe diarrhea, and has been widely used in veterinary medicine to treat ruminal disorders since the 17th century. There were anecdotal reports of the use of parental feces to treat antibiotic-associated diarrhea in children, but these cases were largely unknown until the publication by Ben Eiseman, an American surgeon, of the first case series in 1958 of 4 patients with pseudomembranous enterocolitis. For years, FMT remained a rarely used, if not forgotten, therapy. The first documented case of confirmed CDI treated with FMT was reported in 1983. Since that time, a growing number of case series and a single randomized controlled trial have described the administration of donor stool using various modalities to successfully treat patients, mostly with recurrent or refractory CDI.
Driven by an epidemic of increasingly virulent and severe C difficile infections, our greater understanding of the human gut microbiome, and favorable headlines in the media, the practice of FMT has recently shown a significant increase in utilization. Some of this interest may be because the perceived "natural" properties of FMT make it appealing to both physicians and the lay public. We have also come to realize that FMT enables use of a logical, low-tech, and relatively inexpensive approach to effectively treat a difficult clinical problem. Despite overwhelmingly positive anecdotal experience from the growing number of physicians who have performed this procedure, as well as evidence from hundreds of published cases, FMT is not yet universally available, although its acceptance is growing. The apparently high efficacy of FMT in treating CDI, compelling animal data on the impact of fecal microbiota in metabolism, and case reports describing successful FMT for treatment of other intestinal disorders has led to growing interest in the potential of FMT to treat other conditions associated with dysbiosis such as metabolic syndrome, obesity, food allergies, IBD, and irritable bowel syndrome (IBS). A number of clinical trials studying FMT for these conditions and others are ongoing.