Fecestransplantatie: wanneer wel en wanneer niet?

• As yet, with cure rates around 85%, recurrent Clostridium difficile infection is the only definite indication for faecal microbiota transplantation.
• Faecal microbiota transplantation induces clinical remission and endoscopic improvements in 24-30% of patients with ulcerative colitis, compared to 5% (water) to 20% (autologous faeces) in placebo-treated patients. Current research focuses on the identification of ‘super donors’, and subgroups of patients in which faecal microbiota transplantation is effective.
• In patients with metabolic syndrome, faecal microbiota transplantation may increase insulin sensitivity. Weight, body mass index, and energy metabolism are not affected by faecal microbiota transplantation in humans.
• In addition to the aforementioned indications, faecal microbiota transplantation is an emerging treatment modality for patients with Crohn’s disease, irritable bowel syndrome, graft-versus-host-disease, and carriage of multidrug-resistant micro-organisms. Randomized controlled trials, comparing faecal microbiota transplantation with placebo treatment, are required to determine the effectiveness of faecal microbiota transplantation in these patient groups.

Conflict of interest and financial support: The authors have reported possible conflicts of interests. ICMJE forms provided by the authors are available online along with the full text of this article.