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Fecal Transplantation
From Reuters Health Information
Fecal Transplants Conquer C. Difficile Infections
By Kate Kelland, Health and Science Correspondent
LONDON (Reuters) Jan 19 - Once a year, every year, Professor Thomas Borody receives a single-stem rose from one of his most grateful patients. She is, he says, thanking him for restoring her bowel flora.
It's a distasteful cure for a problem that's increasingly widespread: Clostridium difficile infections can be hard to treat with antibiotics. But Dr. Borody is one of a group of scientists who believe the answer is a fecal transplant.
Some jokingly call it a "transpoosion." Others have more science-y names like "bacteriotherapy" or "stool infusion therapy." The process involves replacing a person's feces with someone else's, and in the process, giving them back the normal intestinal flora they desperately need.
Dr. Borody's grateful patient, Coralie Muddell, suffered months of chronic diarrhea so bad she would often embarrass herself in public, and had even stopped eating to try to halt the flow.
The technique that cured her has had a success rate of around 90% in the experimental cases where it has been used so far. Now scientists are taking it to the next level, with randomized controlled trials to establish whether it can really be a viable option when antibiotics have failed.
With rates of hospital-acquired C. difficile infection rising in the U.S., Europe and other parts of the world, that could save lives as well as reducing expensive days of extra care. "There's rising recognition of how effective this is," Dr. Borody, a gastroenterologist based in Sydney, Australia, told Reuters.
YUCK FACTOR
There's little doubt this treatment has an image problem. Feces, including important bowel flora, is transferred from a volunteer donor -- screened to limit possible other infections -- into the colon of the infected patient. The treatment can be administered by a colonoscope or an enema, or by the mouth or the nose.
"I used to be frowned upon and called 'the doctor who makes people eat ****,'" said Dr. Borody, whose scientific papers have included such titles as "Flora Power" and "Toying with Human Motions." But he is also deadly serious. One of his published studies reported that in patients with recurrent C. difficile infection, 60 out of 67 (90%) of those who received fecal transplants were cured.
Dr. Alex Khoruts, a gastroenterologist at the University of Minnesota Medical School in the United States, agrees that the science is not to be sniffed at. "The data are very strong," he said in a telephone interview. "There is no question that it works."
Dr. Khoruts published a study in the Journal of Clinical Gastroenterology in 2009 that showed a single infusion of feces reversed the absence of bacteroides -- a group of bacteria vital to the body's ability to withstand infections with C. difficile.
Dr. Khoruts often sees patients who have taken course after course of antibiotics. As soon as the treatment stops, the infection returns. It doesn't take much for these sufferers to listen to a new treatment idea, even if it involves feces.
"The patients I see don't have any qualms about it," he says. "By the time I see them, they've often been sick for anywhere from 6 months to 2 years, so they're quite desperate. Nothing really scares them."
The main aim, he says, is to "keep the poo pure."
"What we try to do is preserve it as close as possible to how it was in the donor. There's no in-between culture or enrichment. We want to transfer as much as we can intact."
The donor feces is filtered to remove some larger particles and then "simply goes through a blender," Dr. Khoruts explained, with a saline solution to liquefy it before it is administered.
He favors methods that avoid going in through the mouth or the nose, which he says may make patients gag.
Dr. Borody's clinic, at the Centre for Digestive Diseases in New South Wales, acknowledges that using a nasojejunal tube -- which goes in through the nose, down the throat and into the stomach -- is not the most attractive method, but argues it is the most reliable way of killing the C. difficile bug and its spores once and for all.
C. DIFFICILE ON THE RISE
Repellent as fecal transplants may seem, if C. difficile trends continue, demand could rise rapidly.
A Europe-wide study published in The Lancet late last year found the incidence of C. difficile infections in hospitals in the region had risen to 4.1 per 10,000 patient days in 2008 from 2.45 per 10,000 patient days in 2005.
The infections can have a range of consequences, from severe diarrhea to blood poisoning, colitis and death.
A 2008 report from the Association for Professionals in Infection Control and Epidemiology (APIC) found that on any single day in U.S. hospitals, there could be 7,000 infections with C. difficile and up to 300 deaths.
The most commonly used antibiotic for C. difficile is metronidazole, and some more severe forms are treated with vancomycin, traditionally seen as the antibiotic of last resort. Like other bacteria, C. difficile can develop resistance to vancomycin, giving it multi-drug-resistant traits that make treatment extremely difficult or impossible.
Dr. Khoruts cites data from 1958, when some of the first scientific papers on the use of fecal transplants were published. They showed the death rate for patients with a type of infection called fulminant C. difficile colitis was 75%.
"Then if you go forward to 2010 -- 52 years later, with the best current medical care and new antibiotics -- the mortality is still 50%," he said. "So we really can't say standard medicine has done that well in 50 years."
"POO IS THE ONLY ANSWER"
Dr. Khoruts now fears that unless the medical establishment embraces the technique, "the majority of people who could benefit from this procedure are not going to get it." Borody says "Poo is the only answer." So why is it not catching on?
Scientific literature over half a century has documented the use of fecal transplants, but the technique has remained on the fringes of medicine. Some experts say a lack of robust trial data may be holding people back -- as well as the obvious and natural aversion to feces as a medicinal product.
To try to address this, a team of specialists in the Netherlands is recruiting around 100 sick and healthy people into a randomized controlled trial to see if the method can be proven.
Although the study is still under way, Dr. Ed Kuijper of the Leiden University Medical Centre, one of those working on it, says the early signs are that fecal transplants will be shown to be effective in patients with recurrent C. difficile infections.
Tackling the image problem is more challenging; but both Drs. Khoruts and Kuijper say scientists are "not very far away" from being able develop a kind of artificial feces that might help.
Laboratory-grown feces would be like a super probiotic, they say, but more powerful by far than any yogurt drink you can buy in a supermarket. It would have the qualities of donor feces without the marketing issues.
"It would be a good idea if synthetic poo would work," says Borody. But he has doubts -- and until he sees some good results with artificial feces, he's sticking with the real thing. "We'd like to get away from poo, but it works the best."
http://www.medscape.com/viewarticle/736025?src=mp&spon=3
Fecal Transplants Conquer C. Difficile Infections
By Kate Kelland, Health and Science Correspondent
LONDON (Reuters) Jan 19 - Once a year, every year, Professor Thomas Borody receives a single-stem rose from one of his most grateful patients. She is, he says, thanking him for restoring her bowel flora.
It's a distasteful cure for a problem that's increasingly widespread: Clostridium difficile infections can be hard to treat with antibiotics. But Dr. Borody is one of a group of scientists who believe the answer is a fecal transplant.
Some jokingly call it a "transpoosion." Others have more science-y names like "bacteriotherapy" or "stool infusion therapy." The process involves replacing a person's feces with someone else's, and in the process, giving them back the normal intestinal flora they desperately need.
Dr. Borody's grateful patient, Coralie Muddell, suffered months of chronic diarrhea so bad she would often embarrass herself in public, and had even stopped eating to try to halt the flow.
The technique that cured her has had a success rate of around 90% in the experimental cases where it has been used so far. Now scientists are taking it to the next level, with randomized controlled trials to establish whether it can really be a viable option when antibiotics have failed.
With rates of hospital-acquired C. difficile infection rising in the U.S., Europe and other parts of the world, that could save lives as well as reducing expensive days of extra care. "There's rising recognition of how effective this is," Dr. Borody, a gastroenterologist based in Sydney, Australia, told Reuters.
YUCK FACTOR
There's little doubt this treatment has an image problem. Feces, including important bowel flora, is transferred from a volunteer donor -- screened to limit possible other infections -- into the colon of the infected patient. The treatment can be administered by a colonoscope or an enema, or by the mouth or the nose.
"I used to be frowned upon and called 'the doctor who makes people eat ****,'" said Dr. Borody, whose scientific papers have included such titles as "Flora Power" and "Toying with Human Motions." But he is also deadly serious. One of his published studies reported that in patients with recurrent C. difficile infection, 60 out of 67 (90%) of those who received fecal transplants were cured.
Dr. Alex Khoruts, a gastroenterologist at the University of Minnesota Medical School in the United States, agrees that the science is not to be sniffed at. "The data are very strong," he said in a telephone interview. "There is no question that it works."
Dr. Khoruts published a study in the Journal of Clinical Gastroenterology in 2009 that showed a single infusion of feces reversed the absence of bacteroides -- a group of bacteria vital to the body's ability to withstand infections with C. difficile.
Dr. Khoruts often sees patients who have taken course after course of antibiotics. As soon as the treatment stops, the infection returns. It doesn't take much for these sufferers to listen to a new treatment idea, even if it involves feces.
"The patients I see don't have any qualms about it," he says. "By the time I see them, they've often been sick for anywhere from 6 months to 2 years, so they're quite desperate. Nothing really scares them."
The main aim, he says, is to "keep the poo pure."
"What we try to do is preserve it as close as possible to how it was in the donor. There's no in-between culture or enrichment. We want to transfer as much as we can intact."
The donor feces is filtered to remove some larger particles and then "simply goes through a blender," Dr. Khoruts explained, with a saline solution to liquefy it before it is administered.
He favors methods that avoid going in through the mouth or the nose, which he says may make patients gag.
Dr. Borody's clinic, at the Centre for Digestive Diseases in New South Wales, acknowledges that using a nasojejunal tube -- which goes in through the nose, down the throat and into the stomach -- is not the most attractive method, but argues it is the most reliable way of killing the C. difficile bug and its spores once and for all.
C. DIFFICILE ON THE RISE
Repellent as fecal transplants may seem, if C. difficile trends continue, demand could rise rapidly.
A Europe-wide study published in The Lancet late last year found the incidence of C. difficile infections in hospitals in the region had risen to 4.1 per 10,000 patient days in 2008 from 2.45 per 10,000 patient days in 2005.
The infections can have a range of consequences, from severe diarrhea to blood poisoning, colitis and death.
A 2008 report from the Association for Professionals in Infection Control and Epidemiology (APIC) found that on any single day in U.S. hospitals, there could be 7,000 infections with C. difficile and up to 300 deaths.
The most commonly used antibiotic for C. difficile is metronidazole, and some more severe forms are treated with vancomycin, traditionally seen as the antibiotic of last resort. Like other bacteria, C. difficile can develop resistance to vancomycin, giving it multi-drug-resistant traits that make treatment extremely difficult or impossible.
Dr. Khoruts cites data from 1958, when some of the first scientific papers on the use of fecal transplants were published. They showed the death rate for patients with a type of infection called fulminant C. difficile colitis was 75%.
"Then if you go forward to 2010 -- 52 years later, with the best current medical care and new antibiotics -- the mortality is still 50%," he said. "So we really can't say standard medicine has done that well in 50 years."
"POO IS THE ONLY ANSWER"
Dr. Khoruts now fears that unless the medical establishment embraces the technique, "the majority of people who could benefit from this procedure are not going to get it." Borody says "Poo is the only answer." So why is it not catching on?
Scientific literature over half a century has documented the use of fecal transplants, but the technique has remained on the fringes of medicine. Some experts say a lack of robust trial data may be holding people back -- as well as the obvious and natural aversion to feces as a medicinal product.
To try to address this, a team of specialists in the Netherlands is recruiting around 100 sick and healthy people into a randomized controlled trial to see if the method can be proven.
Although the study is still under way, Dr. Ed Kuijper of the Leiden University Medical Centre, one of those working on it, says the early signs are that fecal transplants will be shown to be effective in patients with recurrent C. difficile infections.
Tackling the image problem is more challenging; but both Drs. Khoruts and Kuijper say scientists are "not very far away" from being able develop a kind of artificial feces that might help.
Laboratory-grown feces would be like a super probiotic, they say, but more powerful by far than any yogurt drink you can buy in a supermarket. It would have the qualities of donor feces without the marketing issues.
"It would be a good idea if synthetic poo would work," says Borody. But he has doubts -- and until he sees some good results with artificial feces, he's sticking with the real thing. "We'd like to get away from poo, but it works the best."
http://www.medscape.com/viewarticle/736025?src=mp&spon=3
I saw this done on a episode of greys anotomy &thought they don't do that in real life & after reading this I quess it happens ..EEWW!
I don't think topical and fecal belong in the same thread. Unless it's a thread on skidmarks.
From FLguy's link:
The doctor who is in Houston is brilliant and corrected the treatment plan that two other docs were doing. Am on Florastor and Align now which are probiotics. After three weeks, still weak but I am eating almost anything that I want without a problem
From FLguy's link:
The doctor who is in Houston is brilliant and corrected the treatment plan that two other docs were doing. Am on Florastor and Align now which are probiotics. After three weeks, still weak but I am eating almost anything that I want without a problem
Topical:
http://boston.cbslocal.com/2011/02/08/cdc-deadly-superbug-c-diff-spreading/
So, I wonder....I you are planning a surgery you can stockpile a suppy of your own blood to be used if it's need. Does it stand to reason that you can pile your own stock in case.....
You might considering publishing in one of the scholarly medical journals.
"...Before I'd resort to poop transplants, or antibiotics it would make sense to figure out if the natural bacteriums, reestablished, could help. Lots of irregularities resolve with minimal effort, and for those who don't want to go the yogurt route there are now myriad brands of pills containing a wide variety of the bacteriums known to restore bowel health. They can be found in almost any grocery store now in the OTC section of the pharmacy. ..."
That's cutting edge stuff.
Mike
"...Before I'd resort to poop transplants, or antibiotics it would make sense to figure out if the natural bacteriums, reestablished, could help. Lots of irregularities resolve with minimal effort, and for those who don't want to go the yogurt route there are now myriad brands of pills containing a wide variety of the bacteriums known to restore bowel health. They can be found in almost any grocery store now in the OTC section of the pharmacy. ..."
That's cutting edge stuff.
Mike
One thing you might find interesting about C-diff....those foams that hospitals prefer these days don't kill C-diff...only soap and water will. So if you visit anyone on the hospital, please don't touch your face (mouth, nose, eyes) until you've washed thoroughly with soap and water. And then use the foam to kill the rest of the stuff you may have picked up during your visit.
Mike, I can see you are dead serious about all this, and I think it's an important topic as we age. Might want to give thought to posting this to the med side maybe??
I'm thinking I'd go with probiotics before any other attempts are made.
Whether antibiotics are safe long term for the bowel is a big debate right now, example would be all the litigation over accutane and it's brethren of late.
This bacterium exists all the time anyway right? So it's just like strep in the throat, we have it all the time, but only when we get an overgrowth does it become problematic.
that said, many americans take drugs that effect colon health, and/or have poor diets that compromise the delicate balance.
Before I'd resort to poop transplants, or antibiotics it would make sense to figure out if the natural bacteriums, reestablished, could help. Lots of irregularities resolve with minimal effort, and for those who don't want to go the yogurt route there are now myriad brands of pills containing a wide variety of the bacteriums known to restore bowel health. They can be found in almost any grocery store now in the OTC section of the pharmacy.
But, if that didn't work, it's good to know that fixaxominicin might help.
mb
I'm thinking I'd go with probiotics before any other attempts are made.
Whether antibiotics are safe long term for the bowel is a big debate right now, example would be all the litigation over accutane and it's brethren of late.
This bacterium exists all the time anyway right? So it's just like strep in the throat, we have it all the time, but only when we get an overgrowth does it become problematic.
that said, many americans take drugs that effect colon health, and/or have poor diets that compromise the delicate balance.
Before I'd resort to poop transplants, or antibiotics it would make sense to figure out if the natural bacteriums, reestablished, could help. Lots of irregularities resolve with minimal effort, and for those who don't want to go the yogurt route there are now myriad brands of pills containing a wide variety of the bacteriums known to restore bowel health. They can be found in almost any grocery store now in the OTC section of the pharmacy.
But, if that didn't work, it's good to know that fixaxominicin might help.
mb
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"Image" problem, yes... but that's the least of its offenses to the senses.
To think all these years I've been flushing good medicine down the toilet...