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Sunday, December 11, 2011

Something to look forward to—fecal transplants

Update 5/13: The FDA is now requiring doctors to use investigational new drug applications before performing the fecal transplants. Whether this leads to black market fecal centers is yet to be seen.

Update 10/12: Another study using donated human stool was recently conducted at Henry Ford Hospital. The results in terms of both efficacy and safety were extremely promising.

As unpleasant as it sounds, fecal transplants may be coming to a hospital near you.  Specifically, the microorganisms within the donated fecal samples can be used to eliminate pathogens such as Clostridium difficile.  No fewer than four studies about the efficacy of fecal transplants were presented at the 76th Annual Scientific Meeting of the American College of Gastroenterology last month.

C. difficile is a well named pathogen. Not only does it cause severe diarrhea, but it can also lead to a potentially life-threatening infection of the colon. In addition, C. difficile is often antibiotic-resistant. Normally, C. difficile is held in check by the ‘friendly’ bacteria in a person’s gut, but following antibiotic treatment, the good microbes are often decimated, leaving room for C. difficile to flourish.  By seeding the gut with a new supply of good bacteria, C. difficile may again be outcompeted to the point of extinction. At least, that’s the reasoning behind the fecal microbe transfer, and it appears to hold true.  In fact, over 90% of patients who undergo this procedure (many of whom have combated C. difficile unsuccessfully for years) have a full recovery.

One caveat: although the evidence is mounting that this procedure is safe and effective (to the point where investigator Lawrence Brandt of the Albert Einstein College of Medicine suggests it should be the first line of attack in treating C. difficile), it hasn’t been thoroughly tested.  For one thing, it’s hard to get NIH grants to study feces.

And in case you were wondering, doctors who perform this procedure sometimes suggest that patients recruit their own donors, often from spouses or other family members.  Now, that’s love.