Warning! Icky post

Last year I heard for the first time about something that sounds (and feels) “icky”, but that on second reflection sounds logical: fecal transplants. Or basically, transplanting stool from someone to someone else.

This is nothing to laugh about. Patients suffering from a very severe diarrhea caused by Clostridium difficile infection are actually helped by it. The infection can be treated by a very heavy antibiotics cure, which kills off the good bacteria in the gut. This means that it is actually rather more difficult to get a good intestine flora going again, and leaving the door wide open for another round of bacteria-related diarrhea. This is a very debilitating disease, sometimes going on for several months or years, with multiple long-stay visits in the hospital.

As a sort of last resort, some doctors thought about transplanting fecal matter from a healthy person, mostly from a relative or spouse. This makes it probably easier to accept from a patient’s perspective, but I think it might probably work better if it is from someone related or living in the same house.

This treatment was first the area of a few pioneer doctors (or lunatics, according to some). But a clinical trial published this week in the New England Journal of Medicine proved them right. The results were simply amazing. 81% of patients with this treatment got better after just one transplant, and another 12% after a second transplant.

Capture

The trial was ended early because of this amazing success. As an extra credit to this, and showing also the desperate situation of some patients, some assigned to the other groups requested to have the same treatment, with again amazing results. The researchers inventing this procedure need a Nobel Prize just for thinking outside of the box. And it’s not just the success rate, it seems from the article that these patients really had a healthier stool, containing a good mix of (healthy) bacteria. This ensures a better recovery and probably a lower chance of relapse.

Now, the sample size in this study is rather small, and it’s not entirely double-blind. The fecal matter gets transplanted via a tube through your nose (!) into your intestines, while the other patients didn’t get this tube, only normal treatments. But given these results, I’m fairly confident to say that this needs to be part of the standard arsenal to treat a C difficile infection.

And if you still cannot get around the ickyness factor (why did you read until the end?), there is hope. In a promising but still preliminary study on two patients, doctors created a “pseudo-poo”, a standardised mix of 33 bacteria found in a healthy gut. This presents a better controlled way to obtain seemingly the same result, without the possible risk of other diseases coming along with the transplant. More importantly, as this is a “preparation”, it might easier pass approval as a treatment from the authorities. Transplanting stool seems to be in a grey area concerning that approval, but this pseudo-stool can follow the normal channels. I just hope they find a better name for this than “pseudo-poo”…

 

About Bruno Van de Casteele

Philosopher by education, IT'er by trade. Allround Armchair Skeptic, History Enthousiast, Father of Three. Twitter @brunovdc Personal website: www.puam.be
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7 Responses to Warning! Icky post

  1. Wordwizard says:

    And here I thought all you needed was to eat yoghurt….

  2. gymgoki says:

    This is fascinating. I first read of this in a case report out of Australia where a man debilitated by Multiple Sclerosis was cured by this same process. In this case report they did mention C. diff. colitis too. I thought the C.diff. was a reasonable target but MS?….who knew. That gastroenterologist was REALLY innovative

    • Bruno Van de Casteele says:

      Cured of MS or cured of a diarrhea linked to / related to MS? The latter sounds possible but I have my doubts about the former.

      • gymgoki says:

        The article said the debilitating movement/weakness resolved and the patient went back to hiking etc. I know THAT sounds crazy. I will try to find the article. As I recall it was in some believable media. It may have been a case report in Lancet…..but of course then….. its the Lancet.

        • caiby says:

          My son is a patient of Prof. Borody who is in Sydney Australia. I believe the article you are referring to may be the one where the man has maintained remission of Parkinson’s disease – he went to Professor Borody for treatment of constipation and his Parkinson’s symptoms gradually disappeared. The story is at http://www.newscientist.com/article/mg20927962.600-faecal-transplant-eases-symptoms-of-parkinsons.html , however I cannot find the full story without subscribing.

          There is also the case study of three patients of Borody who had MS and have remained in remission at the time of the publication for up to and over 12 years with no relapse. They were also treated with FMT for constipation and their symptoms surprisingly disappeared. The article is printed here – http://www.fecalmicrobiotatransplant.com/2012_08_01_archive.html

          I am in awe of Prof. Borody – he became a pioneer of the treatment in the mid 80s when he had a patient who had picked up a seemingly untreatable colitis in her travels. She was terribly ill. He searched old medical references and found a treatment that was used successfully by a Dr B Eiseman on four patients with colitis back in 1958. Borody’s patient was well within a day or two of the FMT and never relapsed. Knowing he was onto something, he has been treating certain conditions with FMT ever since – his tenacity in the face of ongoing skepticism and ridicule by fellow doctors is worth mentioning – if ever a nobel prize were to be awarded, Professor Borody should not be overlooked. He was also the inventor of the triple antibiotic therapy for helicobacter and was one of Marshall and Warren’s (nobel laureates) first converts, working closely with them on their discovery. Good video on him and the treatment here.
          http://www.fecalmicrobiotatransplant.com/2012/08/dr-tom-borody-video-fecal-microbiota.html

  3. mud says:

    There is a posit that clostridial overgrowth may be a cause for subsequent autisms. Its the sort of thing that probably warrants further reading.

    As to the C-diff overgrowth, the treatment may make sense. I have read and watched lectures that real probiotics (ie a pharmaceutical variety of a bug collection) may indeed be an approach.
    One wonders if the stomach wouldnt sanitise half the bugs out and leave just more spore formers to make their way down the GI tract.

    Yoghurt and la la land probiotics.. I suppose they work for perfectly healthy people.

    Should you peruse the EB literature (be careful what you wish for) you will see very many posits towards probiotics and their efficacy. The adoption of a specific brand of yoghurt or capsule will not protect you from a nasty disease nor prevent food poisoning from bad food. But that is not what they claim.

    As Bruno suggested, MS is an entirely different kettle of fish. A case study of cure is not a journal paper, its a case study and shame on the originators for not seeking free glory using non required funding.

    Thats what you should think when reading a case study like the one quoted.

    Why isnt there a similar paper to Helicobacter pylori not immediately published after the case study. Its worth a reference to a Nobel in medicine..

  4. gymgoki says:

    Sorry I got distracted….The article to which I refer is in a supplement of the American Journal of Gastroenterology. I can’t seem to get the abstract nor article. I believe it to be legit since other peer reviewed articles to refer to it, as does the second article below. The second article also refers to other non-GI treatments.

    Borody TJ, Leis S, Campbell J, et al. (2011). “Fecal Microbiota Transplantation (FMT) in multiple sclerosis (MS)”.A j gastroenterol 106: s352

    Agito MD, et al. “Fecal microbiota transplantation for recurrent C difficile infection: Ready for prime time?”Cleve Clin J Med. 2013 Feb;80(2):101-8.

    I find this fascinating. I was scoffed off the stage in 1987 when I presented the possibility of stomach ulcers being caused by an infection as described in: Marshall BJ (September 1985). “The pathogenesis of non-ulcer dyspepsia”. Med. J. Aust. 143 (7): 319. So I have a gut feeling that they are right. (I hope you can stomach my pun.)

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