Talk:Fecal microbiota transplant

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May I see the applicator again please?
Couldn't resist. Sorry. — Preceding unsigned comment added by Blondesareeasy (talk • contribs) 01:49, 18 December 2012 (UTC)

A
A well written text, but some major POV biases, unfortunately. I don't think fecal enemas are considered promising therapy for UC or CD in the GI community. Maybe for PMC, but as last ditch therapy. -- Samir धर्म 09:30, 26 January 2006 (UTC)
 * Our job is to summarize actual research on the topic, not create a positive feedback loop of parroting the biases of people who haven't seen the research —Preceding unsigned comment added by 76.85.197.50 (talk) 13:20, 17 January 2009 (UTC)
 * That I agree with. -- Samir 06:08, 19 October 2009 (UTC)

I beg to differ, it is a valid alternative, and since it has not yet been sufficiently researched (but has shown some extraordinary results), I think it is fair to call it promising. It is interesting though that this procedure may have much of the same theoretical background as another new treatment, helminthic therapy, so who knows, in a few years new knowledges may arise from lessons learned here. In any case, I have no objections if you want to add something or NPOV it if you feel it is too biased, so please, be bold ;-) Dr.Gonzo 03:24, 27 January 2006 (UTC)

Reference?
The external links do not exist or discuss fecal therapy. Is there a current reference other than an isolated paper in 1958? Kd4ttc 00:15, 14 March 2006 (UTC)


 * Well, if you bothered to look you would see the current references in the "publications" section of the web site. This is the website of the clinic doing the research, so I think it's relevant. I'm putting it back, along with direct links to the articles (.pdf format). --Dr.Gonzo 00:23, 15 March 2006 (UTC)

There is an updated article with many references. This is now considered 'mainstream' as more doctors use this method around the world. Take a look. http://patients.uptodate.com/topic.asp?file=gi_dis/32751


 * Interesting, do you have a link to the full article? --Dr.Gonzo 22:41, 4 January 2007 (UTC)

I am aware of 20 peer-reviewed scientific publications on fecal bacteriotherapy for Clostridium difficile-associated disease (CDAD). All are case series, and a few (smae first author) refer to the same or overlapping sets of patients. CDAD (a.k.a. pseudomembranous colitis)is the primary application for bacteriotherapy, althgough there have been at least 2 publications for other indications. Given that zero of the CDAD publications are from Dr. Borody, I think it is misleading that he is the only source in the "history" section. A better reference would be to Eiseman (1958) as the first publication, and Aas (2003) as the most cited U.S. publication. The 20 publications I know of about bacteriotherapy and CDAD are:

Eiseman, B. Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery. Vol 44, No 5, pp 854-859 (1958)

Bowden, T. Pseudomembraneous enterocolitis: mechanism of restoring floral homeostasis. The American Surgeon. Vol 47, pp 178-183 (1981)

Aas, J. Recurrent Clostridium difficile colitis: case series involving 18 patients treated with donor stool administered via a nasogastric tube. Clinical Infectious Diseases. Vol 36, pp 580-585 (2003)

Schwan, A. Relapsing Clostridium difficile enterocolitis cured by rectal infusion of homologous faeces. The Lancet. Vol 322, pp 8354 (1983)

Schwan, A. Relapsing Clostridium difficile enterocolitis cured by rectal infusion of normal faeces. Scandinavian Journal of Infectious Disease. Vol 16, pp 211-215 (1984)

Flotterod, O. Refraktaer Clostridium difficile-infeksjon. Tidsskr Nor Laegedoren. Vol 11, pp 1364-1365 (1991)

Lund-Tonnesen, S. Clostridium difficile-assosiert diare behandlet med homolog feces. Tidsskr Nor Laegeforen. Vol 118, pp 1027-1030 (1998)

Gustafsson, A. Faecal short-chain fatty acids in patients with antibiotic-associated diarrhoea, before and after faecal enema treatment. Scandinavian Journal of Gastroenterology. Vol 33, No 7, pp 721-727 (1998)

Gustafsson, A. The effect of faecal enema on five microflora-associated characteristics in patients with antibiotic associated diarrhoea. Scandinavian Journal of Gastroenterology. Vol 33, No 7, pp 721-727 (1998)

Persky, S. Treatment of recurrent Clostridium difficile-associated diarrhea by administration of donated stool directly through a colonoscope. American Journal of Gastroenterology. Vol 95, No 11, pp 3283-3285 (2000)

Faust G. Treatment of recurrent pseudomembranous colitis (RPMC) with stool transplantation: report of 6 cases. Canadian Journal of Gastroenterology Vol 16 (Suppl. A), No 43A (2002)

You, D. Successful treatment of fulminant Clostridium difficile infection with fecal bacteriotherapy. Annuals of Internal Medicine. Vol 168, No 8, pp 632-633 (2007)

Jorup-Ronstrom, C. Fecal culture successful therapy in Clostridium difficile diarrhea. Lakartidningen Vol 103, No 46 3603-3605 (2006)

MacConnachie, A. Fecal transplant for recurrent Clostridium difficile-associated diarrhoea: a UK case series. QJM Vol 102, No 11 pp 781-784 (2009)

J Yoon, S. Treatment of Refractory/Recurrent C. difficile-associated Disease by Donated Stool Transplanted Via Colonoscopy: A Case Series of 12 Patients. Clinical Gastroenterology. 2010 May 11. [Epub ahead of print]

Russell, G. Fecal Bacteriotherapy for Relapsing Clostridium difficile Infection in a Child: A Proposed Treatment Protocol. Pediatrics. Jun 14. (2010)

Silverman, M. Success of self-administered home fecal transplantation for chronic Clostridium difficile infection. Clinical Gastroenterology and Hepatololgy. Vol 8, No 5, pp 471-473 (2010)

Rohlke, F. Fecal flora reconstitution for recurrent Clostridium difficile infection: results and methodology. Journal of Clinical Gastroenterology. J Clin Gastroenterol. May 18 epub (2010)

Khoruts, A. Changes in the composition of the human fecal microbiome after bacteriotherapy for recurrent Clostridium difficile-associated diarrhea. Journal of Clinical Gastroenterolgy. Vol 44, No 5, pp 354-360 (2010)

Garborg, K. Results of faecal donor instillation therapy for recurrent Clostridium difficile-associated diarrhoea. Scandinavian Journal of Infectious Diseases. Early online (2010) 75.70.152.97 (talk) 21:32, 27 September 2010 (UTC)Nicholas

Celiac Disease
This procedure shows promise for treatment of Celiac Disease. https://www.celiac.com/articles.html/the-origins-of-celiac-disease/more-evidence-links-gut-bacteria-to-celiac-disease-r1343/ —Preceding unsigned comment added by Bizzybody (talk • contribs) 01:52, 20 June 2009 (UTC)

Two Cancer Studies Find Bacterial Clue in Colon (cancer)
http://www.nytimes.com/2011/10/18/health/18cancer.html?ref=science — Preceding unsigned comment added by 195.74.246.132 (talk) 21:05, 19 October 2011 (UTC)

apart from Colon Cancer also speaks of Cecial Disease and Chron recent research link to Fusobacteria — Preceding unsigned comment added by 195.74.246.132 (talk) 21:10, 19 October 2011 (UTC)

SciAm resource
Swapping Germs "A potentially beneficial but unusual treatment for serious intestinal ailments may fall victim to regulatory difficulties" by Maryn McKenna Scientific American December 8, 2011

99.190.83.205 (talk) 04:44, 22 November 2011 (UTC)
 * See Talk:Clostridium_difficile. 99.181.134.134 (talk) 04:59, 29 November 2011 (UTC)
 * Just the near identical Talk:Clostridium_difficile ? - Rod57 (talk) 13:51, 10 January 2013 (UTC)

Synthetic stool
Synthetic Stool Stymies Stubborn C. Difficile describes a synthetic stool for treating CDI. Possibly worth a mention in the article ? - Rod57 (talk) 13:34, 10 January 2013 (UTC)

CDD acronym
"At the CDD there were indications that FMT could benefit other conditions including ulcerative colitis,[28][29] autoimmune disorders,[30] neurological conditions,[7] obesity, metabolic syndrome and diabetes,[15] and Parkinson's disease.[8]"

C-Drone-Defect? Cats Don't Dance? Chlorine dioxide disinfection? — Preceding unsigned comment added by Autharitus (talk • contribs) 14:21, 10 February 2013 (UTC)

Ulcerative Colitis
The portion of the "Theory" section explaining why this technique may treat ulcerative colitis does not make sense. Regardless of whether or not UC has an infectious etiology, it's clearly an autoimmune disease. It is not a logical step saying that because C. difficile - an infection, is treated with fecal transplant, then UC - an autoimmune disease, can be treated with a fecal transplant. Mizower 13:54, 21 June 2013 (UTC)

FDA regulations
According to this article in the NYT, many doctors who were doing stool transplants are refusing to do so, because the FDA has classified therapeutic stool as a drug, and it can only be used in clinical trials. Unfortunately, this story didn't check its facts with the FDA, so I don't know how much is true.

http://opinionator.blogs.nytimes.com/2013/07/06/why-i-donated-my-stool/ Private Lives July 6, 2013, 2:54 pm Why I Donated My Stool By MARIE MYUNG-OK LEE

--Nbauman (talk) 19:21, 7 July 2013 (UTC)

Re: Your Nbauman intro. Liked it. Especially the part stating if people can't comprehend the gist of the subject, re-write it. This isn't a oomprehensive medical encyclopaedia, it's a starting point for a cross-reference. // blondesareeasy in Redondo Beach. — Preceding unsigned comment added by Blondesareeasy (talk • contribs) 19:33, 2 September 2013 (UTC)


 * I have started a new section about regulatory issues. Int21h (talk) 00:18, 13 October 2014 (UTC)

BBC Article
Fairly lengthy article, might be worth citing or point to some cites: http://www.bbc.co.uk/news/magazine-27503660 EdSaperia (talk) 14:43, 27 May 2014 (UTC)

Copyright issues
The entire page appears to be copied almost word for word from the World Heritage Encyclopedia. Link to page http://www.worldheritage.org/article/WHEBN0003762041/Fecal%20bacteriotherapy — Preceding unsigned comment added by 75.183.47.148 (talk) 15:47, 4 March 2015 (UTC)
 * Which is a mirror site, so it's more likely it copied us. Doug Weller (talk) 08:30, 17 June 2015 (UTC)

Cross species
What would happen if the procedure in the article was undertaken on a person with the feces of another species. A horse, for instance. Or, maybe our closest relatives. Chimps / Bonobo's.

Is it possible to speculate what would happen? — Preceding unsigned comment added by 89.151.151.176 (talk) 10:44, 8 March 2015 (UTC)

Article title
Currently, this article is titled fecal bacteriotherapy, however the bold text in the lead is fecal microbiota transplant (FMT), with stool transplant as a secondary term.

Ideally, the first bolded term would match the article title; should we rename the article to fecal microbiota transplant, or should we adjust the lead to primarily reference fecal bacteriotherapy?

As a reference, here are the article naming criteria. —danhash (talk) 16:05, 1 June 2016 (UTC)
 * I just moved fecal bacteriotherapy to fecal microbiota transplant to match the lead; "fecal microbiota transplant" also seems to be the more common name. —danhash (talk) 22:44, 12 June 2016 (UTC)

Response to "Side Effects"
Since this section was not previously on the page, this is a useful contribution to the site. The author used several notable primary sources from which they found important information on how this treatment can affect the patient in other ways that are not intended by the execution of the procedure. The author also used some results of scientific trials that were observed by medical research scientists. Another thing worth noting was the explanation of how other parts of this transplant may have their own side effects. Overall, i believe this is a good contribution with potential to be the seed of a great section of this page as more research is done and added to it. JHunziker (talk) 04:27, 22 November 2016 (UTC)

Formatting for citations?
I'm mostly curious about the formatting as the medical citation website mentioned a couple different methods of citations, but to follow the page for what is being done. As a masters level student I see many different citation formats and would like to be correct in hopes of adding to Wikipedia, ,(QUESTION 1) Which format should I be using since it doesn't appear to have a standard as noted on the main page? I was sending this as I am still new to this editing process and also didn’t want to interpret statements incorrectly or use the wrong format. My understanding is the following will be the template for entering citations, (QUESTION 2) Does it make a difference if I use the vertical or horizontal format?

The Mechanism of action section "The hypothesis behind fecal microbiota transplant rests on the concept of bacterial interference, i.e. using harmless bacteria to displace pathogenicorganisms.[citation needed]"

The hypothesis as noted is spoken to with “The process is based on the restoration of the healthy flora in the diseased colon by importing the colonic microbiota of a healthy subject” (Cammarota et. al, 2015, p. 836). (1) This is within source #20 already mentioned in the article. The hypothesis as noted above is spoken to with “One such therapy is fecal microbiota transplant (FMT), or the infusion of a fecal suspension from a healthy individual into the gastrointestinal tract of a patient with CDI” (Brandt, et. al, 2012, p. 1080). (2) The hypothesis as noted above is spoken to with “This begs the question as to how such dramatic treatment works, and whether it could be used or modified to cure other bowel conditions that may be infection-driven. Tvede et al. demonstrated in vitro how some but not other bacteria can profoundly inhibit the growth of pathogenic strains (6). A similar although less powerful phenomenon has been described for lactobacillus GG (11). It would seem that inhibitory substances, perhaps bacteriocins elaborated by bacteria, possess powerful antimicrobial properties” (Borody, 2000, p. 3028).(3)

This first reference is already there as #20, so would I just use ? Or write the whole thing out as:

2nd paragraph is- Brandt LJ, Aroniadis OC, Mellow M, Kanatzar A, Kelly C, Park T, et al. Long-Term Follow-Up of Colonoscopic Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection. Am J Gastroenterol Camb. 2012 Jul;107(7):1079–87.

Borody TJ. “flora power”--fecal bacteria cure chronic C. difficile diarrhea. Am J Gastroenterol Camb. 2000 Nov;95(11):3028–9.

Thank you for your help I look forward to hearing back about what my next step to edit this is. AverageleveledIQ (talk) 02:39, 5 December 2017 (UTC)

I did not have time to closely analyze the question's details, but I wanted at least to share major principles for entering references, which may help answer the big-picture question: Hope this helps. Quercus solaris (talk) 03:06, 8 December 2017 (UTC)
 * 1) In general, any good-faith addition of references is great, so don't let the mechanical details stop you. Someone can always refine those if they feel the need.
 * 2) Do your best to follow the existing ref style on each page, but point 1 is more important.
 * 3) In general, a reference is defined at first use as, and then thereafter it can be re-cited (i.e., additional citations of same ref) if it is given a name, which is done with an attribute in the tag: . Additional citations then take the form  (notice the slash).
 * 4) If you follow the above, it should be enough to let you contribute, and the rest is optional.
 * 5) By the way, there is a way to enter just a PMID and have the software automatically fill in the author, title, date, etc. Let me know if you want more info on this.

I wasn't sure how to directly reply, so I figured this would be the easiest way to ask, but yes. How can I use only the PMID and get the full source? Also is there a way to use the DOI and possibly do the same? I figure I could just put the title into pubmed to search and get the PMID, but just curious for other easy ways to enter citations. Also, did you move my original question to the bottom of the feed because that is where the most recent should be (top-oldest -> bottom-newest)? Thanks for helping. AverageleveledIQ (talk) 20:17, 9 December 2017 (UTC)


 * Hi. Regarding "top-oldest -> bottom-newest": Yup, just the norm on Wikipedia talk pages, but no worries, as one wouldn't expect a recently arrived user to know that. Regarding ways to import ref data without having to manually cut/paste/type it all piece-by-piece: I just recently learned from other Wikipedia editors that there is now a way to import refs by PMID and, yes, by DOI as well. It seems that it can be done either with the visual editor or the wikitext editor. For the latter (which is how I am now doing it), you have to enable it for yourself (i.e., for your own user account) by going to Special:Preferences, and activate "New wikitext mode". Then, when you are editing, there is a toolbar button called "Cite", on which you go to the "Templates" dropdown menu and click "Cite journal", whereupon a dialog box pops open in which you can paste the PMID or DOI and click the magnifiying glass icon (meaning "look this up"), and it will create the ref with all the fields filled in. Let me know if any trouble finding this. Thanks for contributing to Wikipedia's medical and health science coverage. Quercus solaris (talk) 18:58, 10 December 2017 (UTC)

Edits on new clinical uses & on the further research area
Hello! I submitted 2 section edits, one to the clinical uses, and one to the research portion. And my edits were redacted and deleted.. The standing section of research is grammatically incorrect, and insufficient. The source linked does not actually discuss the topic listed there, though this concept does exist, and I found a summary medical article that discusses this research phenomenon and their study, as well as a primary source article on this research.

Secondly, for the clinical uses portion, I found a primary research article that shows a new clinical use for an FMT that was not listed in the slightest fashion on the present edition of the page. I thought that both edits were sensible, not copyright infringing, and helpfully informative to anyone reading about the uses and potential uses of FMTs... — Preceding unsigned comment added by Maynorsn (talk • contribs) 18:23, 23 April 2018 (UTC)
 * Thanks for using the talk page instead of edit warring. Good on you.
 * Please read and follow WP:MEDRS. If you don't understand it after you read it, please ask.  The sources you have used are not OK. Jytdog (talk) 18:25, 23 April 2018 (UTC)


 * I will look again at this document, but I'm not quite understanding which qualification you're saying these article lack. — Preceding unsigned comment added by Maynorsn (talk • contribs) 18:28, 23 April 2018 (UTC)


 * Further, I do not see any error with posting a primary source or summary review article under the further research area of the wiki page, which seems to be used for the purposes of showing the new and not entirely substantiated development of these topics. Regardless, the current edition of this wiki page's research area had a mis-cited source / content claim. The substance of this section are not actually located in the material of the cited source. Maynorsn (talk) 18:31, 23 April 2018 (UTC)
 * I just saw that you edited two sections at once. The topmost one relies on PMID 28586116 which is a primary source and not OK. Following MEDRS is not optional. If you don't understand why MEDRS has broad and deep consensus in the community, please read WP:Why MEDRS?.
 * The second section was based on PMID 23639085 which is a bit old but OK. That content (ironically) uses the word "currently", which we don't use per WP:RELTIME (this is the irony - the source is already 5 years old and near out dated.... yet the content said "currently"... that will only get more absurd with time, right?)  I will restore that bit and copyedit it and fix the citation.
 * With regard to citations, please always cite the PMID. This is described in WP:MEDHOW and should have been discussed in your training.  Jytdog (talk) 18:33, 23 April 2018 (UTC)
 * So, you will add back the Further Research edits with source after copyediting? I also think that this section can also reasonably hold the information on the new clinical use for FMT with hepatic encephalopathy since that is a primary research piece and also is a continuing research endeavor in this field. Maynorsn (talk) 18:41, 23 April 2018 (UTC)
 * Please read about "research" sections in WP:MEDMOS. your suggestion is not OK. Jytdog (talk) 18:42, 23 April 2018 (UTC)
 * See the message on your talk page here. Jytdog (talk) 18:45, 23 April 2018 (UTC)

Mea culpa here. I am one of the instructors in this class and failed to make clear to the students what the expected process when the content they contributed is removed. It does not happen often, and if there is a silver lining is how much the students care, and it does not seem to be only related to their grading. They put a good amount of time in researching the topic, teaching us about it in class, and preparing a contribution to Wikipedia. I appreciate that and will try hard to be more helpful in a future course.TMorata (talk) 12:25, 26 April 2018 (UTC)

Editing donor selection and specimen prep portion
It seems there was some back and forth on the editing so I was just going back through the portion I had in my sandbox about the donor selection and specimen prep since it was needing many citations. Though there were citations and sections added, some citations do not say what is cited as it stands now, and some are well off on their numbers. For example, the volume of stool required via the wiki says "200-300 grams" yet the cited source says 50 grams. I'll leave the sources which can be used as they are placed, but in case you see your notation gone, please re-read your article in context with the content currently with it. Also it seems there are some "More research is needed" type wording that is left over. Please note WP:MEDMOS about this. Thank you to those who did add the extra articles for me to read as I do love a good source. AverageleveledIQ (talk) 00:03, 10 May 2018 (UTC)


 * After sleeping on it and reviewing the next day, I wonder if I may have overstepped the MEDMOS regarding "You give technical advice, particularly for the steps in a thorough diagnostic workup" for the specimen prep section. Though specimen preparation in my mind means some discussion about "how-to", I may have crossed MEDMOS. Though I'm unsure about reverting it as some citations did not match up with information in article or were outdated. I'm unsure about walking the line between prep and writing in this style so I appreciate an outside voice, feel free to be bold if you prefer. Thank you AverageleveledIQ (talk) 16:51, 10 May 2018 (UTC)

Clarification DESPERATELY needed in section "Donor Selection"
I added the "Clarification Needed" tag to the sentence "Although a close relative is often the easiest donor to obtain and have tested, they may be a disadvantage as they may be an asymptomatic carrier of C. difficile." because I would assume this is relevant only when fecal transplants are used as a treatment for C. difficile infections, (otherwise why would a relative be any more likely to have an asymptomatic C. difficile infection than someone who is not a relative..?) but the sentence is written as though it is a universal issue. This should be clarified. The sentence is written as though C. difficile infections are the only time that fecal transplants are ever performed. However, Fecal transplants are used for many different indications besides just C. difficile infections. This is an incredibly vague sentence and desperately needs to be clarified and fixed! Vontheri (talk) 20:29, 15 December 2018 (UTC)


 * Vontheri, Thank you for noting this, and I see what you mean when the sentence stands alone. You are correct in your thinking that the family member of the person with an active C. diff infection may be more prone to being an asymptomatic carrier of C. diff than a random person (page 5 of the Bakken article).
 * As far as clarification, for the donor selection, what about "Close relatives are often chosen on account of ease of screening,(citations) however in the case of treatment of active C. diff the family members may be more prone to be carriers themselves.(citations)" Utilizing the comma to separate the two ideas: donor selection usually person close to recipient, and pitfalls/exceptions to using donor close to recipient in case of C. diff. I would also be ok with changing the comma to a period to fully separate the ideas entirely, with the pitfalls/exceptions sentence moving to the end of the paragraph after the screening process for chronic diseases, ova/parasites, etc. is discussed. Something like: Though there isn't a standard method of selection, close relatives are often utilized on account of the ease to obtain and test samples.(citations) - then: In the case of C. diff infections intimate contacts may be at higher risk of being an asymptomatic carrier.(citations) With the full split the sentences in that paragraph's sentence themes would read as: 1-prep and screening, 2-who is the donor being selected, 3-what is screened for, 4-exceptions to who. I lean towards the full split. Any thoughts on these two ideas? AverageleveledIQ (talk) 13:55, 2 March 2019 (UTC)


 * Thanks for responding. Either of your suggestions sounds fine to me, but I think the first suggestion might flow a bit better for the reader.


 * For both suggestions, I'm wondering if there is a citation that says that "close relatives are often chosen"? I know that, at least in some cases, (maybe just when it's being done as part of a study, or perhaps depending on the lab) they specifically don't allow people to have any say in who their donor is, requiring it to be an anonymous donor. That's probably a minority of the time, though.  I'm only really familiar with specifics of fecal transplants in the context of studies for Multiple Sclerosis. Vontheri (talk) 23:06, 2 March 2019 (UTC)


 * Thanks for your input, I'll change it to the one that you think will flow better. You are correct in your statement of anonymity of donation within a study (especially in "blinded" studies). As the Bakken et. al. study references all your questions I'll refer you to their article. It's on page 5, section II, subsection a. As a friendly heads up, the information is based on C. diff primarily on account of the scope of the article. My experience with FMT is its use to treat CDI, so it's nice we are both able to bring different viewpoints and experiences to the table. Most of the readings I've found about FMT are also related to CDI (though admittedly in the articles there are mentions of other applications).


 * To answer about donor preference: the Bakken article also discusses some theoretical advantages to maternal line first degree relatives. I left that information out as it was discussed as theoretical, as well as seemed tangential which goes against MED:MOS. Other articles I read through didn't specify a preference but some note both known and unknown donors are utilized.
 * Bakken et al. 2011 note that it is easier for close friend/relative and they may be better, and may also be a asymptomatic carrier of CDI.
 * Borody et al. 2012 speak to the responsibility of selection of donor is on the treatment center.
 * Brandt et al. 2012 note that of donors 60%-spouses, 27%-first degree relative, but didn't note why they were selected.
 * Cammarota et al. 2015 note they wanted healthy volunteers less than 50 years of age (preference to relative/intimate contact).
 * Merestein et al. in 2014 reference typically family members, as well as non-familial, and frozen specimens.
 * A systematic review prepared by Timothy J. Wilt, MD for the Veterans Affairs department utilized a few, but it doesn't speak directly to our donor selection preference. (I'm sorry about that citation if it isn't in the right format, I had to manually put it in)
 * Smits et al. in 2013 usually recruited family members, but sometimes utilized newspaper adverts.
 * van Nood et al. in 2013 used volunteer donors they screened with a questionnaire, but didn't note how they found the volunteers.


 * With all that said, I agree with changing to the single sentence for sake of flow. I'll let you remove the clarification needed part if the new sentence is clearer and has fixed the original problem. Also, I'm new to the wiki editing still and don't know how to remove it :/ AverageleveledIQ (talk) 17:15, 5 March 2019 (UTC)


 * Thanks! That's much better now.  I removed the "clarification needed" tag.  For future reference, to remove such a tag, (or a "citation needed" or any other tag), just remove the relevant code while in the editor.  For example, for this one the relevant code was ‎{ {clarify |date=December 2018 |reason=It's unclear if this is saying this is only an issue when fecal transplants are being used to treat C. difficile infections, or if this is relevant for all indications of fecal transplants.}}   (Without the space between the first two "{" brackets.  I had to put the space so it would show it as text instead of making the tag.)


 * I'll respond to the rest of what you said soon when I have more time. Vontheri (talk) 20:18, 5 March 2019 (UTC)