Up to 1000 microorganism species live in your digestive tract. Most are harmless or helpful under normal circumstances. But when something upsets the bacterial balance in your gut, Clostridium difficile(C. difficile or C. diff) can grow out of control. Patients suffer from a dangerous form of diarrhea, abdominal pain, nausea and fever. Loss of appetite, weight loss, dehydration, kidney failure and life-threatening colitis can develop.
One unusual treatment is drawing attention and astonishment. The thought of a fecal microbiota transplant (FMT), the transfer of beneficial bacteria from one person’s colon to another’s, is disgusting. But for patients with the pernicious C. diff bowel infection, rebalancing their gut bacteria can be a life-changing blessing.
Infection Has Become an Epidemic
C. diff infection (CDI) has increased to epidemic proportions. Each year, roughly 250,000 Americans require hospital care for this digestive tract infection, according to the U.S. Centers for Disease Control and Prevention (CDC). Between 2000 and 2007, a new and stronger strain of the bacteria caused annual deaths to skyrocket from 3000 to 14,000. So the CDC identified this rapidly spreading bacteria as an urgent public health threat.
Recurrent infections pose particular clinical challenges because up to 25 percent of people need additional therapy. Patients shed C. diff in their feces. Any surface, device or material that feces touch may serve as a reservoir for C. diff spores. Transfer occurs mainly via the hands, so hand washing, wearing gloves, cleaning and disinfection are vital to prevent this infection from spreading.
Multiple Studies Confirm FMT Cures C. Diff
A review of over 300 fecal transplants through colonoscopies, enemas and nasal tubes reported a 92 percent cure rate. FMT restored patients’ bacterial diversity in a recent study. In most cases, patients’ post-transplant intestinal microbiota began to resemble their donors’ healthy type.
Other researchers found that fecal transplantation is a safe and effective C. diff treatment in high-risk immunocompromised patients. Colleen Kelly, M.D., a gastroenterologist in the Center for Women’s Gastrointestinal Medicine at The Women’s Medicine Collaborative in Providence, R.I., led the study published in the American Journal of Gastroenterology.
Kelly’s team reviewed the records of 75 adult and five pediatric patients who received colonoscopy-administered fecal transplants for CDI. Immunocompromised reasons included HIV/AIDS, solid organ transplant, oncologic conditions, immunosuppressive therapy for inflammatory bowel disease and other medical conditions such as cirrhosis and end-stage kidney disease.
Analysis found an overall success rate of 89 percent. Unrelated serious adverse effects such as hospitalization occurred in 12 patients within 12 weeks of the procedure. Some patients with inflammatory bowel disease experienced disease flares after transplant, but no subject suffered infectious complications related to FMT.
The Evolution of This Ancient Method
Fecal transplant isn’t a new idea. The first use of FMT in Western medicine dates back to 1958, but using stool to heal had been part of Chinese medicine since the 4th century. In those days, physicians had patients drink a medicinal yellow soup that contained fecal matter.
Luckily, Dr. Lawrence J. Brandt, a gastroenterologist at the Albert Einstein College of Medicine in New York, pioneered another administration method. An older female C. diff patient begged him to come up with an experimental treatment in 1999. He told her that the person sitting next to her — her husband of over 50 years — might have the answer. If Brandt introduced her husband’s bacteria using his stool, her infection might clear up. Brandt revived and refined the ancient procedure with great success. His patient claimed she’d never felt better.
Since then, Brandt has performed over 150 FMTs. He also has upgraded his initial concept so the donor’s and recipient’s bacterial populations don’t need to be similar. Blood tests screen out prospective donors with HIV or hepatitis C. People with autoimmune diseases, diabetes or obesity also may not qualify.
Fast Forward to Today
When Brandt performed his first transplant, no one else was using that technique. Now he estimates that about 50-75 U.S. doctors perform the procedure on hundreds of patients a year. Dr. Maria Oliva-Hemker, chief of pediatric gastroenterology and nutrition at Johns Hopkins Children’s Center, is a proponent.
With her first patient under general anesthesia, she used the side channel or hollow pipe alongside the fiber-optic video part of a colonoscope. Oliva-Hemker passed a fluid containing the father’s stool and a saline solution into the daughter’s colon and sprayed it throughout her large intestine. The girl went home from the hospital the same day. Since her transplant, she hasn’t experienced any CDI symptoms.
“I’ve been in medicine for a little more than 40 years,” Brandt said, “and I don’t think I’ve ever done anything that has helped as many people and changed as many lives as fecal transplant has.”
Researchers are hopeful that they will have an easier way to transfer good bacteria in pill form soon. In a recent small study, capsules of donor bacteria cured 30 of 31 patients.
Other CDI Treatment Options
If you can’t stomach this solution, your doctor may prescribe a 10-day course of an antibiotic. Taken orally, Vancomycin remains in your intestines, where it stops the growth of the bacteria responsible for C. diff.
Drinking plenty of water and other liquids or getting intravenous fluids can help guard against dehydration from diarrhea. Probiotics are good bacteria that colonize in the gut and may help keep CDI from recurring when you take them along with prescription medication.