Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2015; 21(38): 10907-10914
Published online Oct 14, 2015. doi: 10.3748/wjg.v21.i38.10907
Gastroenterologist perceptions of faecal microbiota transplantation
Sudarshan Paramsothy, Alissa J Walsh, Thomas Borody, Douglas Samuel, Johan van den Bogaerde, Rupert WL Leong, Susan Connor, Watson Ng, Hazel M Mitchell, Nadeem O Kaakoush, Michael A Kamm
Sudarshan Paramsothy, Alissa J Walsh, Gastroenterology and Hepatology Department, St Vincent’s Hospital, Sydney, Darlinghurst NSW 2010, Australia
Thomas Borody, Centre for Digestive Diseases, Sydney, Five Dock NSW 2046, Australia
Douglas Samuel, Rupert WL Leong, Gastroenterology and Hepatology Department, Bankstown-Lidcombe Hospital, Sydney, Bankstown, NSW 2200, Australia
Johan van den Bogaerde, Gastroenterology and Hepatology Department, Nambour General Hospital, Nambour, QLD 4560, Australia
Susan Connor, Watson Ng, Gastroenterology and Hepatology Department, Liverpool Hospital, Sydney, Liverpool NSW 2170, Australia
Hazel M Mitchell, Nadeem O Kaakoush, University of New South Wales, School of Biotechnology and Biomolecular Sciences, Kensington, NSW 2052, Australia
Michael A Kamm, Departments of Gastroenterology and Medicine, St Vincent's Hospital and University of Melbourne, Melbourne, Fitzroy VIC 3065, Australia
Author contributions: Paramsothy S, Walsh AJ, Borody T, Samuel D, van den Bogaerde J, Leong RWL, Connor S, Ng W, Mitchell HM, Kaakoush NO and Kamm MA designed the research and devised the research questionnaire; Paramsothy S and Walsh AJ participated in the acquisition of the data; Paramsothy S, Borody T and Kamm MA analyzed and interpreted the data; and Paramsothy S, Walsh AJ, Borody T, Mitchell HM and Kamm MA drafted the manuscript.
Supported by The Clinical trial (ClinicalTrials.gov Identifier: NCT01896635) this study was performed in conjunction with has received funding from the Broad Medical Research Program at CCFA and the GESA IBD Clinical Research Grant.
Institutional review board statement: The clinical trial (ClinicalTrials.gov Identifier: NCT01896635) this study (involving a voluntary anonymous survey of gastroenterology colleagues) was performed in conjunction with was reviewed and approved by the St Vincent’s Hospital Human Research Ethical Committee.
Informed consent statement: All respondents provided written informed consent acknowledged by completion and return of the anonymous survey.
Conflict-of-interest statement: Paramsothy S, Walsh AJ, Samuel D, van den Bogaerde J, Leong RWL, Connor S, Ng W, Mitchell HM, Kaakoush NO and Kamm MA have no financial or potential competing interest or affiliation with any institution, organization, or company relating to the manuscript. Borody T has an interest in the Centre for Digestive Diseases, where faecal microbiota transplantation is a treatment option for patients and has filed patents in this field.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael A Kamm, Professor, Departments of Gastroenterology and Medicine, St Vincent's Hospital and University of Melbourne, Victoria Parade, Melbourne, Fitzroy VIC 3065, Australia. mkamm@unimelb.edu.au
Telephone: +61-3-94175064 Fax: +61-3-94162485
Received: March 30, 2015
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.

Keywords: Perceptions, Gastroenterologist, Clostridium difficile, Inflammatory bowel disease, Faecal microbiota transplantation

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.