Fecal transplant may not be a popular topic at the dinner table, but it has proved to be an effective treatment for a dangerous kind of gut bacterial infection: Clostridium difficile.
Antibiotics can wipe out the good bacteria in a patient’s gut, leaving the patient susceptible to infections like Clostridium difficile. As its name suggests, Clostridium difficile, or C difficile (C. diff), is a formidable foe. For starters, it causes colitis, a painful inflammation of the colon with symptoms including severe diarrhea and abdominal pain. In extreme cases, C. diff can be fatal. According to the Centers for Disease Control and Prevention, it causes 15,000 deaths each year.
A 2013 study published in the New England Journal of Medicine found that fecal transplant, which also goes by the formal name of fecal microbiota transplantation (FMT), was more effective at treating C. difficile than antibiotics. The results were so dramatic that researchers ended the study early because they believed it was unethical to deny the antibiotic cohort access to FMT. At this point, however, the U.S. Food and Drug Administration has approved fecal transplants only for people with C. diff not responding to antibiotics or that keeps coming back.
FMT is part of a growing arsenal of microbiome-based therapies. The human microbiome is made up of the communities of microbes that live in the gut, eyes and nasal passages as well as on the skin. These peaceful invaders, which outnumber our own human cells, play a large role in our health and disruptions in their ecosystem can cause illness.
Fecal transplants involve inserting fecal material from a healthy person into the gut of a sick one. First, donor feces are screened for pathogens to ensure that donors are not harboring infections that could harm the recipients. Then, by introducing fecal matter that is teaming with good bacteria, the body is repopulated with infection fighters.
Physicians typically insert the poop through a colonoscopy or a tube that snakes from the nose to the stomach. After the procedure, patients sometimes feel better within hours and typically within days. While not yet widely available, in recent years researchers have developed a pill that offers a less invasive alternative to the procedure.
Fecal transplants have a history that goes back thousands of years. Ancient Chinese medical books contain references to using dried feces as a treatment for abdominal diseases. Veterinarians have also used fecal transplants to treat horses with diarrhea for more than 100 years.
“C. diff has become an epidemic. Fecal transplants are a great treatment alternative because they are low-risk, comparatively low-cost and extremely effective,” said Dr. Amy Barto, a gastroenterologist and researcher at Lahey Hospital & Medical Center.
“Since 2011, we’ve done more than 400 transplants at Lahey Hospital & Medical Center,” said Dr. Barto. “As one of the largest open access transplant centers in New England, we perform multiple transplants weekly for both outpatients and patients in the hospital. Patients do not need to be part of a clinical trial.”
The idea of receiving a fecal transplant may trigger a squeamish gut reaction, but for patients suffering from persistent C. diff, FMTs offer a solution that can significantly improve quality of life. The symptoms associated with these illnesses, including severe diarrhea, can cause patients to become socially isolated because they fear being far from a bathroom. By resolving a patient’s physical symptoms, an FMT can also work wonders in improving psychological health.
“This is one of the most promising gastrointestinal treatments that has come along in a long time,” said Dr. Barto. “We anticipate that in coming years the treatment may be indicated for other illnesses, including inflammatory bowel disease and irritable bowel syndrome.”