The American Gastroenterological Association (AGA) has developed guidelines for using fecal microbiota-based therapies, including conventional fecal microbiota transplant and FDA-approved options. These guidelines cover the treatment of gastrointestinal conditions such as recurrent Clostridioides difficile infection (CDI), severe CDI, inflammatory bowel diseases, and irritable bowel syndrome. The guidelines were created using the GRADE framework to address clinical questions and provide patient-centered recommendations. The AGA suggests selective use of fecal microbiota therapies in immunocompetent and mildly immunocompromised adults with recurrent CDI but recommends against their use in severely immunocompromised patients. For patients hospitalized with severe or fulminant CDI who are not responding to standard antibiotics, the AGA supports the use of conventional fecal microbiota transplant.
The guideline also advises against using fecal microbiota transplant as a treatment for inflammatory bowel diseases or irritable bowel syndrome outside of clinical trials. Overall, fecal microbiota-based therapies are recommended primarily to prevent CDI recurrence in specific patient groups.
Reference: Peery AF, Kelly CR, Kao D, et al. Electronic address: clinicalpractice@gastro.org. AGA Clinical Practice Guideline on Fecal Microbiota-Based Therapies for Select Gastrointestinal Diseases. Gastroenterology. 2024 Mar;166(3):409-434. doi: 10.1053/j.gastro.2024.01.008. PMID: 38395525.
