Digestive Diseases and Sciences

, Volume 63, Issue 1, pp 193–197 | Cite as

Small Intestinal Bacterial Overgrowth: Should Screening Be Included in the Pre-fecal Microbiota Transplantation Evaluation?

  • Jessica R. Allegretti
  • Zain Kassam
  • Walter W. Chan
Original Article



Fecal microbiota transplantation (FMT) is safe and effective for recurrent Clostridium difficile infection (rCDI) and often involves terminal ileal (TI) stool infusion. Patients report gastrointestinal (GI) symptoms post-FMT despite rCDI resolution. Small intestinal bacterial overgrowth (SIBO) screening is not routinely performed pre-FMT. The effect of donor/recipient SIBO status on FMT outcomes and post-FMT GI symptoms is unclear. We aim to evaluate the value of pre-FMT SIBO screening on post-FMT outcomes and symptoms.


This was a prospective pilot study of consecutive adults with rCDI undergoing FMT by colonoscopy at a tertiary center. Routine pre-FMT screening and baseline lactulose breath tests (LBTs) were performed for donors and recipients. Positive LBT required a rise > 20 ppm in breath hydrogen or any methane level > 10 ppm within 90 min. The presence of GI symptoms and CDI resolution were assessed 8 weeks post-FMT. Fisher’s exact/Student’s t tests were performed for statistical analyses.


Twenty recipients (58.3 years, 85% women) enrolled in the study. Fourteen (70%) FMTs involved TI stool infusion. Four (20%) recipients and six (30%) donors had positive LBT pre-FMT. At 8 weeks post-FMT, 17 (85%) recipients had CDI resolution and five (25%) reported GI symptoms. Pre-FMT LBT result was not associated with post-FMT CDI resolution or GI symptoms. There was a trend toward increased GI symptoms among recipients receiving stool from LBT-positive donors (50 vs 14.2%, p = 0.09).


FMT is effective and well tolerated for rCDI. Positive LBT in asymptomatic donors may have an effect on post-FMT GI symptoms. Larger studies are needed.


Clostridium difficile Fecal microbiota transplantation Small intestinal bacterial overgrowth Lactulose breath test Diarrhea 


Author’s contribution

JRA and WWC initiated study concept and design. JRA contributed to acquisition of data, analysis and interpretation of data, and drafting of the manuscript. ZK and WWC contributed to interpretation of data and critical revision of the manuscript.

Compliance with ethical standards

Conflict of interest

ZK is employed at OpenBiome, a nonprofit stool bank that provides clinicians with preparations for fecal microbiota transplantation and supports research into the human microbiome. ZK also receives research support and has equity in Finch Therapeutics. JRA consults for Finch Therapeutics. There were no other conflicts of interest to report for any authors relevant to the work presented in this manuscript.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Jessica R. Allegretti
    • 1
    • 2
  • Zain Kassam
    • 3
    • 4
  • Walter W. Chan
    • 1
    • 2
  1. 1.Division of Gastroenterology, Hepatology and EndoscopyBrigham and Women’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.OpenBiomeSomervilleUSA
  4. 4.Division of Biological EngineeringMassachusetts Institute of TechnologyCambridgeUSA

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