Fever, debilitating diarrhea, severe abdominal pain. One might think this was a description of Ebola, the headline-grabbing deadly disease killing thousands in Africa and causing chaos and confusion in America. But these are symptoms of another condition causing pain and suffering to those who are afflicted with it: Clostridium difficile infection. C. difficile is a bacterium that releases toxins that attack the intestinal lining and cause inflammation of the colon.
According to the Centers for Disease Control and Prevention, C. difficile is linked to a quarter of a million hospitalizations and 14,000 deaths a year in the U.S. Deaths from C. difficile increased 400 percent between 2000 and 2007, due in part to the emergence of a stronger strain. And a study in the October issue of the American Journal of Infection Control reports that the incidence of C. difficile in hospitals nearly doubled between 2001 and 2010, with mortality increasing from 6.6 percent in 2001 to 7.2 percent in 2010.
Those especially at risk for C. difficile infections are people on long-term antibiotics for other conditions, which can destroy the balance of bacteria in the gut and thus lead to an overgrowth of bad bacteria like C. difficile. Incredibly infectious, C. difficile spores can be found in feces and spread from touching a contaminated surface or person’s hand — particularly in hospitals and long-term care facilities. Antibiotics are a common course of treatment, but reinfections often occur: Statistics show that up to 40 percent of first-time patients will suffer again, while up to 65 percent of patients who’ve experienced two episodes are doomed for another.
There is a treatment, though, that has proven successful for people crippled by this infection: fecal microbiota transplantation, the process of populating the intestine with normal bacteria by using stool from a healthy individual.
The use of feces for medical treatment dates back to fourth century China, where it was orally given to those suffering from food poisoning or severe diarrhea. In 16th century China, a fecal suspension called “yellow soup” was created for the relief of constipation, fever, pain, diarrhea and vomiting. In 1958, fecal enemas were first used to treat pseudomembranous colitis; 25 years later, they were administered for C. difficile infections. Today, the delivery of donor stool to treat C. difficile is often done by a colonoscopy, but researchers have found a method proven to be just as effective and less invasive.
A study published in October in JAMA showed that the ingestion of frozen fecal matter contained in capsules resulted in a 90 percent success rate among subjects suffering from recurring C. difficile infections. Stool was obtained from healthy volunteers who had abstained from antibiotics during the previous six months and were screened for conditions including HIV and hepatitis A, B and C. The subjects — having endured at least three episodes of mild to moderate C. difficile infections or two severe episodes requiring hospitalization — were given 15 capsules on two consecutive days, and then observed for up to six months. Their daily number of bowel movements dropped from a median of five a day prior to the first capsule to two on day three and one at week eight. Subjects experienced no serious side effects.
With results like these, the advantages of using frozen fecal matter in encapsulated form to treat C. difficile are great. The process allows for the advance screening of donors and further testing for incubating viral infections prior to prescribing the capsules. Plus, “capsules take 10 minutes on two days and have essentially no risk, while a colonoscopy is a medical procedure which involves anesthesia, or at least sedation, a full bowel clean out, limited diet prior to the procedure, some risk, arrangements for travel to and from the hospital and supervision after,” says study author Elizabeth Hohmann of the Massachusetts General Hospital Infectious Diseases Division, who’s also an associate professor of medicine at Harvard Medical School. “Additionally, the minimum cost for a colonoscopy is about $2,000. The other option, which is nearly as precise, involves a nasogastric tube with an X-ray to check position, followed by funneling liquid stool down into stomach. Thus you can see why capsules present a more convenient solution.”
The JAMA study authors note that FMT may become a more accessible and potentially safer process to treat C. difficile. The use of frozen fecal matter allows for the advance screening of donors and further testing for incubating viral infections prior to prescribing the capsules. It would also do away with the cost and complications associated with invasive procedures like the colonoscopy.
The use of FMT for other gastrointestinal diseases is also garnering attention. One study found that 70 percent of subjects undergoing fecal transplantation for irritable bowel syndrome experienced a significant improvement or disappearance of symptoms such as abdominal pain, bowel movements, bloating and gas. And a study in the June 2013 issue of the Journal of Pediatric Gastroenterology and Nutrition reported that 78 percent of participants who had been given fecal enemas for the treatment of ulcerative colitis experienced less symptoms a week after the procedure. Thirty-three percent would show no symptoms after the process.
Currently, fecal microbiota transplantation awaits formal approval from the U.S. Food and Drug Administration for use in treating C. difficile infections. Still, it’s “the most rational, simple and effective form of treatment for recurrent C. difficile infection we have at present,” says Lawrence J. Brandt, a professor of medicine and surgery at Albert Einstein College of Medicine. “It’s remarkably free of severe adverse effects, at least in the short term.”
Brandt, who has been performing fecal microbiota transplantation since 1999, strongly believes that “[it] is the first step in a journey that ultimately will take us into the realm of designer microbiotic therapy for a wide of range of diseases. This goal is looming on the horizon as basic and clinical scientists continue to explore the role of our microbiome in various diseases.”
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Stool for Success: the Power of Fecal Microbiota Transplantation originally appeared on usnews.com
