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Warning! Icky post

by Bruno Van de Casteele

January 20, 2013

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Donate 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 severediarrhea caused byClostridium difficileinfection 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.

The trial was ended earlybecause of this amazing success. As an extra credit to this, and showing also the desperate situation of some patients, some assigned tothe 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 obtainseemingly 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"...


by Bruno Van de Casteele

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