January 17, 2013
Fecal Transplants As Effective As They Are Disgusting
Michael Harper for redOrbit.com — Your Universe Online
It´s difficult to turn down promising options when you have a debilitating or chronic illness. It´s completely daft to turn your nose up at an option for treatment when your life is on the line.
Medical science, as it often does, is once again pushing the boundaries of what that layman perceives as a last-ditch treatment option. According to a new paper published in The New England Journal of Medicine (NEJM) this week, when antibiotics aren´t enough to cure recurring infections from Clostridium difficile bacteria, a fecal transplant may do the job.
You read that correctly — a fecal transplant.
The recently published study has found that these transplants cured 15 out of 16 people with recurring Clostridium difficile bacteria infections. By contrast, traditional antibiotics only cured 3 to 4 patients out of 14 with the same illness.
Patients with this recurring infection lack a normal balance of bacteria in their intestines to ward of these attacks. The fecal transplants are said to restore order in the gut, delivering the right amount of good bacteria and fighting off Clostridium difficile.
Dr. Josbert Keller, a gastroenterologist at the University of Amsterdam and co-author of this study, claims this procedure provides patients and doctors with options when standard treatments simply aren´t working.
Though 10 percent of his patients declined to receive the unusual procedure — perhaps understandably so — 94 percent of those who went through with the it were cured.
To perform a fecal transplant, doctors must obtain a stool sample from a healthy donor with the right balance of bacteria in their stomachs. This sample is then diluted with a saline solution. At this point, doctors have 3 options for entry when injecting this liquified sample into the patients gut, either via enema, colonoscope or a tube run through the nose and into the small intestine. Once injected, the sample goes to work, delivering with it the right amount of bacteria in the patients stomach.
Doctors aren´t yet sure which bacteria are responsible for restoring order to the patients´ troubled bowels. Therefore, they must use the entire sample to ensure whichever bacteria lives within finds its way to where it´s needed.
This procedure has been used periodically as a last option for many years. While various medical journals have reported high success rates from these rare procedures in the past, Dr. Keller´s research is the first to provide solid proof (no pun intended).
“Those of us who do fecal transplant know how effective it is,” explained Dr. Colleen R. Kelly, a gastroenterologist in Rhode Island, speaking to the New York Times. “The tricky part has been convincing everybody else.” Kelly was not involved in Dr. Keller´s study.
Professor James Versalovic with the Baylor College of Medicine and Texas Children´s Hospital put it another way: "This could be viewed as another form of recycling: one man's waste is another man's treasure,” he said speaking to USA Today.
Versalovic has also said Texas Children´s hospital has already begun their own fecal transplant program, giving it the innocuous title “intestinal microbiome transplantation.”
While the transplants have been found to be quite effective, Dr. Keller worries that the offensive nature of the procedure may prevent people from seeing its clear medical benefits.
"The challenge for the future is the development of a powerful mixture of bacteria that can replace donor feces as an effective treatment," says Dr. Keller. As such, he hopes to one day discover which bacteria is the “good” bacteria and develop a procedure which isolates this specific bacteria for injection, rather than having to inject an entire stool into a patient´s gut.