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Updated: Aug 10, 2026
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Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Colonoscopic or Capsule Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection: A
Dina Belhasan1, Nataliia Kuchma2, Monika Fischer3
1Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Gastro Hep Advances
|August 8, 2026
Summary
Fecal microbiota transplant (FMT) via capsule may lead to higher recurrent Clostridioides difficile infection (rCDI) rates than colonoscopic FMT, especially in older adults. This highlights the need for individualized treatment decisions in CDI prevention.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Microbiome Research
Background:
- Fecal microbiota transplant (FMT) is a proven treatment for recurrent Clostridioides difficile infection (rCDI).
- Previous research suggests comparable efficacy between capsule and colonoscopic FMT, but with limitations in sample size and potential selection bias.
- The optimal administration route for FMT in rCDI remains an area of investigation.
Purpose of the Study:
- To compare the rates of CDI recurrence after FMT administration via capsules versus colonoscopy.
- To identify predictors of CDI recurrence following different FMT administration routes.
- To evaluate the impact of patient age on the efficacy of capsule versus colonoscopic FMT.
Main Methods:
- A prospective cohort study included 652 patients with rCDI treated with either capsule (n=421) or colonoscopic (n=223) FMT.
- The primary outcome was the 1-month CDI recurrence rate.
- Multivariate logistic regression was used to assess predictors of recurrence, with stratified analyses by age.
Main Results:
- Capsule FMT recipients were older (median 70 vs 59 years).
- One-month CDI recurrence was significantly higher with capsule FMT (18%) compared to colonoscopic FMT (7.4%) (P=.001).
- Capsule FMT was independently associated with increased rCDI risk (aOR: 2.37), particularly in patients aged 65 years and older.
Conclusions:
- FMT administered via capsules may be associated with a higher risk of CDI recurrence than FMT via colonoscopy.
- This increased risk appears more pronounced in patients aged 65 years and older.
- Administration route is a critical factor influencing FMT efficacy for CDI, necessitating personalized treatment strategies.
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