Fecal Transplants

Writer: Sam Hyde, M.S. PhD, MPH

One of our members recently saw a TV show PBS series called ‘Second Opinion’ where fecal transplants were discussed as having a 91% success rate for curing C-Diff. Since people with digestive tract issues many times have problems with C-Diff, we asked our Science Advisor, Dr. Sam Hyde, to research this procedure. Below are her findings:

Fecal Transplantation Therapy

Clostridium difficile (C. difficile) is a bacterium related to those that cause tetanus and botulism. It causes gastrointestinal infections that can be potentially life-threatening. Patients most at risk for C. difficile infections include those who have recently been on antibiotics, those who have been treated in an inpatient hospital setting, and those with feeding tubes1. C. difficile is therefore of particular interest to patients with gastroparesis and other chronic digestive disorders. Traditional antibiotic therapies are often ineffective in curing C. difficile infections; thus, new techniques are being developed to treat patients suffering from this disease. One such therapy is known as fecal transplantation, and has been used with considerable success in a number of cases1-3.

Nearly 90% of C. difficile infections are caught in a hospital setting1. Patients who have been on antibiotics are at a particularly high risk for infection, as antibiotics kill the “good” bacteria that normally lives in the gut, leaving the intestine vulnerable to disease-causing bacteria like C. difficile1. These disease-causing bacteria are resistant to antibiotics, and so can quickly spread throughout the intestines. In the case of C. difficile, this results in severe diarrhea, and can cause dehydration.

Because C. difficile infections often occur when the good bacteria in the gut have been killed, one approach to fighting C. difficile is to put new good bacteria in the gut. This, essentially, is the goal of fecal transplantation. Feces (poop) contain a very high level of bacteria that come from the gut, so feces from healthy people contain a lot of good bacteria. The approach is thus simple, if a little “aesthetically unpleasing.” Feces from a healthy patient are introduced into the gut of someone with a C. difficile infection. The bacteria from the feces can then grow and get rid of the C. difficile. In non-scientific terms: poop from a healthy person is put into a sick person to restore the good bacteria that have been killed.

Fecal transplantation can be remarkably effective, with over 80% of patients showing immediate improvement1, 2. However, barriers exist to such treatments. For one thing, the FDA has had trouble deciding how to regulate the procedure4; fecal transplantation is currently considered an experimental procedure5. Also, physicians may be unaware or uncomfortable with performing fecal transplantation, and there is always the “ick factor” to consider. Finally, diseases can be transferred with the fecal transplant if the feces are not screened for diseases. Still, when considering the dangers of C. difficile infections and the high success rate of fecal transplantations in treating such infections, it is likely that fecal transplantation will play an increasingly important role in clinical practice.

Sam Hyde, M.S. PhD, MPH


Useful Websites:

  1. http://www.mayoclinic.org/medical-professionals/clinical-updates/digestive-diseases/quick-inexpensive-90-percent-cure-rate
  2.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365524/
  3. http://www.foxnews.com/health/2014/06/27/fda-grapples-with-oversight-fecal-transplants/

Sources:

  1. Iv EC, Iii EC, Johnson DA. Clinical update for the diagnosis and treatment of Clostridium difficile infection. World J Gastrointest Pharmacol Ther 2014;5(1):1-26. 
  2.  Petrof EO, Gloor GB, Vanner SJ, et al. Stool substitute transplant therapy for the eradication of Clostridium difficile infection: ‘RePOOPulating’ the gut. Microbiome 2013;1(1):3. 
  3.  Borody TJ, Warren EF, Leis SM, Surace R, Ashman O, Siarakas S. Bacteriotherapy using fecal flora: toying with human motions. J Clin Gastroenterol 2004;38(6):475-83. 
  4.  PERRONE M. FDA GRAPPLES WITH OVERSIGHT OF FECAL TRANSPLANTS. In: Associated Press. http://hosted.ap.org/dynamic/stories/U/US_FECAL_TRANSPLANTS_FDA?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2014-06-26-12-06-42; 2014. 
  5. FDA. Guidance for Industry: Enforcement Policy Regarding Investigational New Drug Requirements for Use of Fecal Microbiota for Transplantation to Treat Clostridium difficile Infection Not Responsive to Standard Therapies. In: Services USDoHaH, Administration FaD, Research CfBEa, eds. Biologics Guidances; 2013.

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