Fecal Microbiota Transplantation in Recurrent Clostridium Difficile Infections: Our Experience in Patients with and without Inflammatory Bowel Disease

The gastrointestinal tract harbors approximately 100 trillion bacterial cells that exist symbiotically to maintain the integrity of the intestinal mucosa and the gut immune system [1,2]. Intestinal homeostasis is achieved by the symbiotic relationship between the host immune system and these microbes. Disruptions of this homeostasis predispose the gastrointestinal tract to increased incidence of enteric infections. This phenomenon is believed to play a role in several intestinal and extra-intestinal diseases such as asthma, atopic diseases, obesity, colon cancer, irritable bowel syndrome, and inflammatory bowel disease [2,3]. Antibiotic use and immunocompromised states have been associated with an increased incidence of Clostridium difficile infection (CDI) [4]. Recent studies have established the role of environmental factors (such as diet, antibiotic use, and NSAID use), and their effect on the gut microbiome in the development of inflammatory bowel disease (IBD) in genetically susceptible individuals [1,5]. Ulcerative colitis (UC) is characterized by continuous inflammatory changes of the superficial layers of the colon, while Crohn’s disease (CD) is characterized by transmural inflammation that can affect any area of the gastrointestinal tract in a patchy manner [6]. Similar gut dysbiosis that occurs in antibiotic use, has also been found in patients with IBD [4]. It is well established that patients with IBD have a higher incidence of CDI than the average population [1,5,7].