Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2016; 22(19): 4757-4765
Published online May 21, 2016. doi: 10.3748/wjg.v22.i19.4757
Chinese physicians’ perceptions of fecal microbiota transplantation
Rong-Rong Ren, Gang Sun, Yun-Sheng Yang, Li-Hua Peng, Shu-Fang Wang, Xiao-Hong Shi, Jing-Quan Zhao, Yong-Ling Ban, Fei Pan, Xue-Hong Wang, Wei Lu, Jian-Lin Ren, Ying Song, Jiang-Bin Wang, Qi-Ming Lu, Wen-Yuan Bai, Xiao-Ping Wu, Zi-Kai Wang, Xiao-Mei Zhang, Ye Chen
Rong-Rong Ren, Gang Sun, Yun-Sheng Yang, Li-Hua Peng, Shu-Fang Wang, Yong-Ling Ban, Fei Pan, Zi-Kai Wang, Xiao-Mei Zhang, Institute of Digestive Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, Beijing 100853, China
Rong-Rong Ren, Medical College of Naikai University, Tianjin 300071, China
Xiao-Hong Shi, Department of Traditional Chinese Medicine, The First People’s Hospital of Hangzhou City, Hangzhou 310006, Zhejiang Province, China
Jing-Quan Zhao, Department of Respiratory, The People’s Hospital of Dongying City, Shandong Province 257091, China
Xue-Hong Wang, Department of Gastroenterology, Affiliated Hospital of Qinghai University, Xining 810001, Qinghai Province, China
Wei Lu, Department of Gastroenterology, First Central Hospital of Tianjin, Tianjin 300192, China
Jian-Lin Ren, Department of Gastroenterology, Affiliated Hospital of Xiamen University, Xiamen 361003, Fujian Province, China
Ying Song, Department of Gastroenterology, Xi’an Central Hospital, Xi’an 710003, Shanxi Province, China
Jiang-Bin Wang, Department of Gastroenterology, China-Japan Union of Jilin University, Changchun 130033, Jilin Province, China
Qi-Ming Lu, Department of Gastroenterology, the People’s Hospital of Gansu, Lanzhou 730000, Gansu Province, China
Wen-Yuan Bai, Department of Gastroenterology, the Second Hospital of Hebei Medical University, Baoding 050000, Hebei Province, China
Xiao-Ping Wu, Department of Gastroenterology, the Second Xiangya Hospital of Central South University, Changsha 410008, Hunan Province, China
Ye Chen, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Author contributions: Yang YS, Sun G conceived and designed this survey; Ren RR, Peng LH, Wang SF, Shi XH, Wang XH, Lu W, Ren JL, Song Y, Wang JB, Lu QM, Bai WY, Wu XP, and Chen Y performed and distributed the questionnaires; Ren RR, Zhao JQ, Ban YL, Pan F, Wang ZK, and Zhang XM analyzed the data; Ren RR wrote the paper.
Supported by Chinese PLA General Hospital, No. 2014FC-TSYS-2001 and No. 2013FC-TSYS-1009; National High-tech Research and Development Projects (863), No. 2015AA020702; National Natural Science Foundation of China, No. 81402345.
Institutional review board statement: The survey study was performed by asking physicians to assess their perceptions using questionnaires with no risk to the participants, and no individual physician information was revealed under the condition of anonymity. Thus, the study was exempt from the requirement for ethical approval.
Informed consent statement: The need for informed consent in this study was waived by the Chinese PLA General Hospital Institutional Review Board because the study was a survey of physicians’ perceptions using questionnaires; there was no risk to the participants, and no individual physician information was revealed under the condition of anonymity.
Conflict-of-interest statement: All authors had no conflicts of interest to declare relevant to this publication.
Data sharing statement: No additional data for the study are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yun-Sheng Yang, MD, Institute of Digestive Diseases, Chinese PLA General Hospital, Chinese PLA Medical Academy, No. 28 Fuxing Road, Beijing 100853, China. sunny301ddc@126.com
Telephone: +86-10-55499007 Fax: +86-10-68212267
Received: January 21, 2016
Peer-review started: January 26, 2016
First decision: March 21, 2016
Revised: March 29, 2016
Accepted: April 7, 2016
Article in press: April 7, 2016
Published online: May 21, 2016

AIM: To explore Chinese physicians’ perceptions towards fecal microbiota transplantation (FMT) and to provide information and an assessment of FMT development in China.

METHODS: A self-administered questionnaire was developed according to the FMT practice guidelines and was distributed to physicians in hospitals via Internet Research Electronic Data Capture (REDcap) software and electronic mails to assess their attitudes toward and knowledge of FMT. The questionnaire included a brief introduction of FMT that was followed by 20 questions. The participants were required to respond voluntarily, under the condition of anonymity and without compensation. Except for the fill-in-the-blank questions, all of the other questions were required in the REDcap data collection systems, and the emailed questionnaires were completed based on eligibility.

RESULTS: Up to December 9, 2014, 844 eligible questionnaires were received out of the 980 distributed questionnaires, with a response rate of 86.1%. Among the participants, 87.3% were from tertiary hospitals, and there were 647 (76.7%) gastroenterologists and 197 (23.3%) physicians in other departments (non-gastroenterologists). Gastroenterologists’ awareness of FMT prior to the survey was much higher than non-gastroenterologists’ (54.3 vs 16.5%, P < 0.001); however, acceptance of FMT was not statistically different (92.4 vs 87.1%, P = 0.1603). Major concerns of FMT included the following: acceptability to patients (79.2%), absence of guidelines (56.9%), and administration and ethics (46.5%). On the basis of understanding, the FMT indications preferred by physicians were recurrent Clostridium difficile infection (86.7%), inflammatory bowel disease combined with Clostridium difficile infection (78.6%), refractory ulcerative colitis (70.9%), ulcerative colitis (65.4%), Crohn’s disease (59.4%), chronic constipation (43.7%), irritable bowel syndrome (39.1%), obesity (28.1%) and type 2 diabetes (23.9%). For donor selection, the majority of physicians preferred individuals with a similar gut flora environment to the recipients. 76.6% of physicians chose lower gastrointestinal tract as the administration approach. 69.2% of physicians considered FMT a safe treatment.

CONCLUSION: Chinese physicians have awareness and a high acceptance of FMT, especially gastroenterologists, which provides the grounds and conditions for the development of this novel treatment in China. Physicians’ greatest concerns were patient acceptability and absence of guidelines.

Keywords: Fecal microbiota transplantation, Chinese physicians, Gastroenterologists, Perception, Survey

Core tip: Perceptions and attitudes toward fecal microbiota transplantation (FMT) by physicians and patients play an important role in determining its acceptability. We investigated Chinese physicians’ acceptance levels of FMT, their concerns about FMT, and their perspectives of FMT techniques. The few data about the perceptions of physicians toward FMT are all from Western countries; this is the first study of physicians’ perceptions of FMT in an Asian country. Additionally, our study was representative with a large respondent number (844) and a large coverage area of China (22 out of 34 provinces); thus it can provide preliminary information for the development of FMT in China.