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AGA now recommends fecal microbiota transplant for the majority of recurrent C. diff patients

However, this new clinical guideline does not recommend FMT for IBD and IBS.

Bethesda, MD (Feb. 21, 2024) — In the first comprehensive evidence-based guideline on the use of fecal microbiota-based therapies for gastrointestinal disease, the American Gastroenterological Association recommends fecal microbiota transplant (FMT) for most patients with recurrent Clostridioides difficile (C. diff) infection.  

“Using fecal microbiota transplant, we take stool from a healthy donor and transfer it to the colon of the person with recurrent C. diff, restoring balance to their gut microbiome,” explains guideline author Dr. Anne Peery. “FMT is a safe and effective treatment with enough scientific evidence to offered to most patients with two or more C. diff recurrences.”  

In the U.S., nearly half a million people each year experience C. diff. One in six of those people will deal with a C. diff recurrence within two to eight weeks.  

For patients with recurrent C. diff infection at a high risk of recurrence: 

  • AGA recommends the use of FMT-based therapy after completing a course of standard-of-care antibiotics. Only severely immunocompromised patients (such as patients who are neutropenic or have received a bone marrow transplant) are excluded from this recommendation. 

For hospitalized patients with severe C. diff infection: 

  • AGA recommends the use of conventional FMT following standard of care antibiotic therapy in select patients if there is no improvement. 

FMT therapies are not recommended as a treatment for inflammatory bowel diseases (IBD) or irritable bowel syndrome (IBS). AGA encourages patients interested in FMT for conditions other than C. diff to participate in a clinical trial.  

Key takeaways  

  • FMT offers hope to patients suffering from recurrent C. diff infection, as a safe and effective treatment. 
  • The majority of patients with recurrent C. diff are candidates and can consider an FMT therapy to prevent recurrence. 

C. diff is debilitating. Thanks to this new American Gastroenterological Association guideline, patients will suffer for shorter periods of time and be able to get back to leading happy and healthy lives,” concluded Amanda Kabage, MS, FMT researcher and FMT recipient who contributed to the development of this guideline. 

This guideline covers the use of conventional FMT, performed most commonly using donor stool delivered via colonoscopy, as well as recently FDA-approved therapies such as fecal microbiota live-jslm (REBYOTA) delivered via enema and fecal microbiota spores live-brpk (VOWST) delivered in an oral capsule.  

Check out AGA’s GI Patient Center resources: 

What is C. diff? 

What is fecal microbiota transplantation (FMT)? 


Learn more about the AGA Fecal Microbiota Transplantation National Registry: 

Media contact: Mara Shapiro, [email protected] 

About the AGA Institute 

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. 

About Gastroenterology 

Gastroenterology is the most prominent journal in the field of gastrointestinal disease. As the official journal of the AGA Institute, Gastroenterology delivers up-to-date and authoritative coverage of both basic and clinical gastroenterology. Regular features include articles by leading authorities and reports on the latest treatments for diseases. Original research is organized by clinical and basic-translational content, as well as by alimentary tract, liver, pancreas, and biliary content. 

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