Fecal Transplants A Superior Cure for Clostridium difficile
The most common cause of C.diff colitis is previous treatment with antibiotics. Antibiotics disrupt the normal flora of the intestines allowing for overgrowth of the usually harmless bacteria. As the bacteria overgrow they release toxins that attack the lining of the intestine. Other risk factors for C.diff include:
- Surgery of the gastrointestinal tract
- Diseases of the colon such as inflammatory bowel disease or colorectal cancer
- A weakened immune system
- Use of chemotherapy drugs
- Previous C. diff infection
- Advanced age -- 65 or older
- Kidney disease
- Use of drugs called proton-pump inhibitors, which lessen stomach acid
Often times antibiotic treatments fail and C.diff recurs. Recurring Clostridium difficle is difficult to treat but as reported in the New England Journal of Medicine, fecal transplants may hold the answer to a successful cure. Infusion of feces from healthy donors has been reported as an effective treatment for recurrent C.diff infections in more than 300 patients. However experience with this procedure is limited by a lack of randomized trials supporting its efficacy. In this study donor feces was infused in patients with recurrent iC. Diff infection and compared with conventional 14 day vancomycin treatment with and without bowel lavage.
Technically the infusion of feces is called a fecal microbiota transplant, or FMT. Healthy donor feces is filtered and thinned with saline solution, then inserted via colonoscopy. The fecal transplants can also be infused by sigmoidoscopy, enema or nasogastric tube.
Not only are fecal transplants successful but this method is effective 94% of the time with recurrent C.diff after 1 or 2 treatments. Traditional treatment with the vancomycin was effective for only 31% of the study patients. No complications or side effects were reported and the cost of the procedure is often less than the cost of the traditionally used antibiotics. Most people who get fecal transplants use feces from family members. While the treatment is inarguably an unappealing option the outcomes appear to be more favorable for this choice.
To add another level of “ick” factor- Dr. Thomas Louie, an infectious disease expert from the University of Calgary, found a way to package donated stool into vitamin-sized capsules used to repopulate the intestines of C. diff sufferers with beneficial bacteria.
Instead of the typical delivery methods, patients gulped two dozen to three dozen gelatin pills filled with feces that had been spun down to the most beneficial microbes. Of the 27 patients treated, none had a recurrence of C. diff, even though all of them had had at least four bouts of the infection, which can lead to severe disease or death. Louie said he has treated a half-dozen more patients since then, with the same result.
Swallowing a handful of feces-filled pills might not sound like a medical breakthrough, but for patients like Shawn Mulligan of Calgary, Canada, the unconventional new treatment has been nothing less than a cure. Mulligan, 53, is one of the first people to get better using fecal transplants delivered not through nose tubes, colonoscopies or enemas — but through poop pills.
