Patient perceptions of fecal microbiota transplantation for ulcerative colitis

Abstract

Background: Fecal microbiota transplantation (FMT), the delivery of stool from a healthy prescreened donor to an individual with disease, is gaining increasing recognition as a potential treatment for inflammatory bowel diseases. Our objective was to describe patient interest in and social concerns around FMT.

Methods: We conducted a survey of adults with ulcerative colitis (UC) seen in outpatient clinic at the University of Chicago IBD Center. All English-speaking patients ≥18 years of age were eligible. Subjects completed a written survey in clinic. Ninety-five participants, median age 39 years, 53% female, were enrolled in the study.

Results: Forty-four percent and 49% reported excellent or good/satisfactory medical management of their UC, respectively. Forty-six percent participants were willing to undergo FMT as a treatment of UC, 43% were unsure, and 11% were unwilling to undergo FMT. Subjects who had been hospitalized were more willing to undergo FMT, 54% versus 34%, P = 0.035. Primary concerns included the following: adequate screening for infections (41%), cleanliness (24%), and potential to worsen UC (18%); 21% reported no specific concerns. For donor selection, an equal number of participants (46%) preferred whomever their doctor recommended or family member/spouse.

Conclusions: In our center despite reporting satisfactory to excellent disease control with their treatments, the vast majority of patients with UC are interested in or willing to consider FMT. Proof of safety and effectiveness, and failure of other medical therapies are key issues in considering FMT. Strong interest in this as-yet unproven therapy warrants attention and is a pressing priority for clinical research and education.

Figure 1

Participants’ self-reported disease severity and willingness to undergo FMT. Patients with more severe disease were more willing to undergo FMT but even patients with mild disease were willing to undergo FMT.

Figure 2

2A) Major factors influencing patient decision making in FMT and 2B) Patient-identified concerns about FMT.

Figure 2

2A) Major factors influencing patient decision making in FMT and 2B) Patient-identified concerns about FMT.

Figure 3

FMT donor preferences. Participants were equally willing to have their physician select the donor as they were to have a family member or spouse serve as their donor.