Bacteriotherapy. Sounds pretty high-tech, right? Might even sound interesting. But what if I told you that bacteriotherapy was just a fancy word for a fecal transplant? It’s gross, I know, but what if I then told you that a fecal transplant can save lives?
The bacteria Clostridium difficile (C. difficile) was responsible for 500,000 infections and 29,000 deaths in 2011. Fecal bacteriotherapy is a procedure that takes stool from a healthy donor’s colon and infuses all the healthy bacteria into the colon of a sick patient. According to a new review, infusion of healthy bacteria through donor stool helped 55 percent of patients heal who did not respond to standard drug treatments.
Dr. Dimitri Drekonja is a staff physician in the department of infectious diseases with Minneapolis VA Health Care System and lead author of a study that was published in the May 5 issue of Annals of Internal Medicine. The review examined the results of two randomized, controlled trials as well as 33 uncontrolled case reports with more than 500 C. difficile fecal transplant patients.
C. difficile is becoming more common, and is often (but not always) triggered by antibiotic use. The biggest problem is that C. difficile often comes back, recurring in 30 percent of patients. In those 30 percent, 40 percent will be infected yet again. The infection is not just uncomfortable. It is potentially life-threatening and is characterized by symptoms such as fever, severe abdominal pain, blood or pus in the stool, and watery diarrhea (up to 15 times per day) which causes significant weight loss.
Fecal transplant helps break the cycle of recurrence for C. difficile. With a fecal transplant, 90 percent of people improve. Although not all C. difficile is brought on by antibiotic use, it is often triggered by antibiotics which eliminate the both the good and the bad bacteria. The infusion of healthy stool helps prevent re-infection.
“So, over the last 15 years, and in particular in the last three to five years, interest in fecal transplant has been growing,” said Drekonja. “Right now, it’s an investigational and invasive procedure and most of the data we have has come from case reports that may or may not be fully representative. But our review, which includes two recent high-quality controlled studies, seems to confirm the largely positive reviews we’ve been hearing about.”
After examining the results of studies on fecal transplants, it is clear that infusion of healthy stool to treat C. difficile is effective and has very few side effects. There are still challenges to overcome, though, such as the drafting of guidelines to screen donor candidates, identifying the best fecal-preparation methods, and deciding how best to deliver stool to patients.
Currently, the evidence that Drekonja has does not meet the FDA’s criteria, but he and his team plan to continue their study of fecal transplants (Source: Health Day).