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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
This story is as yuck factored as the guy who ate worm eggs to get rid of his IBS that was out recently. I guess desperate times for desperate people but man oh man...........gross.
Thanks for the intriguing article, Michael.
While I’m sure Goofydad will happily provide long and colorful commentary on this topic (and indeed he’s eminently qualified), I on the other hand am intensely curious as to where you come up with these gems. Not all of us are committed pooplogists, so it’s wonderful to have one among us. I guess this is one case where having the graft ‘take’ isn’t an attractive outcome? Any thoughts on that :o)? I suppose rejection occurs universally, eh?
Keep up the good work, my friend—
Bill
While I’m sure Goofydad will happily provide long and colorful commentary on this topic (and indeed he’s eminently qualified), I on the other hand am intensely curious as to where you come up with these gems. Not all of us are committed pooplogists, so it’s wonderful to have one among us. I guess this is one case where having the graft ‘take’ isn’t an attractive outcome? Any thoughts on that :o)? I suppose rejection occurs universally, eh?
Keep up the good work, my friend—
Bill
I get a lot of medical information in my email box and I always look through them. I saw the title and was immediately intrigued - I couldn't imagine what the article was about.
Apparently Clostridium difficile can be a serious disorder and this approach evidently works.
When I posted it - after serious deliberation - I hoped some members would find it of interest. It is pretty far out there.
Mike
Apparently Clostridium difficile can be a serious disorder and this approach evidently works.
When I posted it - after serious deliberation - I hoped some members would find it of interest. It is pretty far out there.
Mike
I actually heard about this on the radio a couple months back.
from the article: ".... so bad she would often embarrass herself in public"
I also frequently embarass myself in public, but that's because I have my head up my a@@, not a condtion that someone else's poo is likely to resolve.
Is it preferable to be the transplator or the transplantee? Neither is an enviable position - clearly the donor is the one sitting on the throne in this triad.
from the article: ".... so bad she would often embarrass herself in public"
I also frequently embarass myself in public, but that's because I have my head up my a@@, not a condtion that someone else's poo is likely to resolve.
Is it preferable to be the transplator or the transplantee? Neither is an enviable position - clearly the donor is the one sitting on the throne in this triad.
“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.”
Not the most attractive method? I suppose it beats serving it on a plate next to the French fries!
Not the most attractive method? I suppose it beats serving it on a plate next to the French fries!
I guess when Webster's gets around to defining "fudgepacking" they have at least two definitions now; a noun and a verb.
Corn specs would certainly improve the presentation.
Who saw Pink Flamingos?
LOL, there is a youtube of the divine $hit eating scene, I forgot how nasty it was. Corn specs might have improved the presentation but perhaps the dog didn't like vegetables.
A little off the subject, but I watched polyester when it first came out in the theatre. they gave you a numbered scratch and sniff card and when the number flashed on the screen you scratch and joyfully added to the experience.
Who saw Pink Flamingos?
LOL, there is a youtube of the divine $hit eating scene, I forgot how nasty it was. Corn specs might have improved the presentation but perhaps the dog didn't like vegetables.
A little off the subject, but I watched polyester when it first came out in the theatre. they gave you a numbered scratch and sniff card and when the number flashed on the screen you scratch and joyfully added to the experience.
I have spent some time reading about C. Diff and it's a pretty nasty disease which doesn't have a good cure rate but which does have a significantly high mortality.
Though this treatment sounds rather rough it's a lot better than dying - if it really works that well.
Mike
Though this treatment sounds rather rough it's a lot better than dying - if it really works that well.
Mike
You're right, of course. But, it does illustrate the difference between morbid and morbidity.
Perhaps the doctor never heard of acidophiles pills. I hate to think of all the people that ate sh*t for nothing.
Now this is too much. Mike, do you sometimes think you have too much time to google? What were you googling anyway?
Hey, goofydad -- I went to Mexico a few years ago and wanted to see a beautiful butterfly called a Malachite which is a bright emerald green - nothing like it in the states. When I finally did spy one, it was on a file of human poop someone had conveniently left on the walking path. The next Malachite I saw was hovering around a public bathroom. Now if anyone mentions that pretty butterfly I just shake my head.
Hey, goofydad -- I went to Mexico a few years ago and wanted to see a beautiful butterfly called a Malachite which is a bright emerald green - nothing like it in the states. When I finally did spy one, it was on a file of human poop someone had conveniently left on the walking path. The next Malachite I saw was hovering around a public bathroom. Now if anyone mentions that pretty butterfly I just shake my head.
I knew I could count on you. And it's good that you were kinda subtle. Directing people to the link http://www.youtube.com/watch?v=FJQsEf70Ti8&feature=related just wouldn't be right.
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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...