American Gastroenterological Association (AGA)’s new evidence-based guideline on the use of fecal microbiota-based therapies (FMT) for gastrointestinal diseases. The key points from the article are:
FMT for Recurrent Clostridioides difficile Infection (CDI): The AGA recommends FMT as a safe and effective treatment option for most cases of recurrent CDI. This recommendation applies particularly to patients at high risk of recurrence following standard-of-care antibiotics and to hospitalized patients with severe CDI who do not improve after standard-of-care antibiotics.
Guideline Development Process: The guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. It involved a panel of AGA members, methodologists, and experts in fecal microbiota-based therapies, along with a patient representative. The panel focused on seven clinically relevant questions using the PICO format (Patient, Intervention, Comparison, Outcome) and reviewed 66 studies to inform the clinical guidance.
Recommendations Against FMT for IBD and IBS: The guideline suggests against the use of FMT therapies for inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), except in the context of clinical trials.
Use of FMT in Immunocompromised Adults: The guideline does not recommend the use of any fecal microbiota-based therapies to prevent recurrent CDI in severely immunocompromised adults. However, it suggests the select use of conventional FMT in mildly or moderately immunocompromised adults with recurrent CDI.
Future Potential of FMT: The guideline panel members foresee potential future uses of FMT in areas like ulcerative colitis as part of IBD, decolonization of multi-drug resistant organisms, and other conditions, although more research is needed to determine the efficacy and safety in these areas.
The article provides insights into the AGA’s recommendations on FMT, highlighting its role in treating recurrent CDI while also noting the limitations and potential future applications of this therapy in other gastrointestinal conditions.