Curing Infectious Diarrhea with Fecal Bacteria

Yes, you read the headline correctly. Transplanting feces from healthy patients into patients with horrible infectious diarrhea is rapidly becoming standard medical practice because of its dramatic positive results.

Contracting an infection from Clostridium difficile (C. difficile) can be deadly. About 6 in 100 hospital patients become infected with the insidious bacterium. People who use proton-pump inhibitors also seem to be at greater risk factor for infection. So says a recent study published in the New England Journal of Medicine.

The study’s authors hope that its findings will promote efforts to prevent this extremely common cause of health-care related infectious diarrhea.

A day after that study hit the news, their wishes seem to have come true.

In a “say what?” solution to the horrors of C. difficile infection, the American College of Gastroenterology reported that transplanting fecal material containing healthy bacteria into C. difficile patients can bring relief even to elderly, debilitated people for whom previous courses of treatment had failed.

As reported on MedPage Today, 9 in 10 “fecal microbiota” transplants were successful. The definition of success was patients who had no recurrence within three months. On average, it took six days for their diarrhea to resolve, and four weeks for their fatigue to resolve.

What seems contrary to common sense – even physicians posting comments on the MedPage story were making bathroom humor jokes – appears to be the new gold standard of care for C. difficile infections. Stool bacterial population of patients with recurrent C. difficile infections, apparently, is completely different from that of normal people. “Therefore,” the study’s lead author said, “it would make sense that if you performed a massive bacterial replacement, that might very well reverse that condition and allow for a cure in people who were otherwise not curable.”

The study is poised to change how gastroentologists – physicians who specialize in disorders of the the stomach, intestines and associated organs – practice.

C. difficile infections are notoriously difficult to treat. Recurrence rates are as high as 1 in 2 patients. Earlier fecal transplant studies showed promise, but their results were derived from only a single treatment center. The new study involved five different U.S. medical centers.

The patient/subjects involved in the new study, according to MedPage Today, had failed an average of five different medication courses before receiving the transplant.

At the risk of someone claiming “too much information!” the question arises: What was the source of the transplanted material? More directly, who were the donors? Most were members of the same household as the patient; only one patient had no relationship with the donor.

One interesting result was that two patients experienced improvement in their pre-existing conditions; one with arthritis and one with sinus allergies. Four patients developed new disorders – peripheral neuropathy (nerve damage involving numbness and pain in hands and feet), Sjogren’s syndrome (an immune problem involving various symptoms), rheumatoid arthritis and idiopathic thrombocytopenia (abnormally low blood platelets of unknown origin). One patient, who was in hospice care, died.

Study subjects did not seem to find the idea of a fecal transplant unpleasant. “They’re desperate people seeking desperate measures so they didn’t have much of a problem with it,” said the study’s primary author. “We have to stop thinking of stool as a smelly inert substance; it’s an incredibly biologically active substance.”

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