Published online Oct 14, 2015. doi: 10.3748/wjg.v21.i38.10907
Peer-review started: March 31, 2015
First decision: June 19, 2015
Revised: July 6, 2015
Accepted: August 31, 2015
Article in press: August 31, 2015
Published online: October 14, 2015
AIM: To explore gastroenterologist perceptions towards and experience with faecal microbiota transplantation (FMT).
METHODS: A questionnaire survey consisting of 17 questions was created to assess gastroenterologists’ attitude towards and experience with FMT. This was anonymously distributed in hard copy format amongst attendees at gastroenterology meetings in Australia between October 2013 and April 2014. Basic descriptive statistical analyses were performed.
RESULTS: Fifty-two clinicians participated. Twenty one percent had previously referred patients for FMT, 8% more than once. Ninety percent would refer patients with Clostridium difficile infection (CDI) for FMT if easily available, 37% for ulcerative colitis, 13% for Crohn’s disease and 6% for irritable bowel syndrome. Six percent would not refer any indication, including recurrent CDI. Eighty-six percent would enroll patients in FMT clinical trials. Thirty-seven percent considered the optimal mode of FMT administration transcolonoscopic, 17% nasoduodenal, 13% enema and 8% oral capsule. The greatest concerns regarding FMT were: 42% lack of evidence, 12% infection risk, 10% non infectious adverse effects/lack of safety data, 10% aesthetic, 10% lack of efficacy, 4% disease exacerbation, and 2% inappropriate use; 6% had no concerns. Seventy seven percent believed there is a lack of accessibility while 52% had an interest in learning how to provide FMT. Only 6% offered FMT at their institution.
CONCLUSION: Despite general enthusiasm, most gastroenterologists have limited experience with, or access to, FMT. The greatest concerns were lack of supportive evidence and safety issues. However a significant proportion would refer indications other than CDI for FMT despite insufficient evidence. These data provide guidance on where education and training are required.
Core tip: This is the first study assessing the experiences, attitudes and practice of gastroenterologists towards faecal microbiota transplantation (FMT) across a range of indications other than just Clostridium difficile infection. Despite general enthusiasm, most gastroenterologists have limited experience with, or access to, FMT. Views differ widely regarding the potential therapeutic role of FMT in various gastrointestinal diseases. Major concerns include lack of evidence and safety data, infection risk, aesthetic factors and possible lack of efficacy. There is limited familiarity with the current evidence base and appropriate indications for FMT highlighting the need for education on where FMT fits in to current clinical practice.