Here in the “crazy” world of alternative medicine we have spices and probiotics, but evidently that is not macho enough for the G.I. docs. Instead they use the fecal transplant, which sounds a whole lot better than “filling you up with someone else’s poop.”
It does work, but in a study of fecal transplants, two patients had other illnesses improve and four others developed new diseases. So maybe we need to spend a little more time finding “matching donors?”
In fact, the recent interest in probiotics has found that some probiotics may make illnesses worse. So look for more scrutiny into fecal transplants in the future.
Currently those researching the use of probiotics like sacchromyces boulardii are attempting single species use during intense antibiotic therapy. The use of fecal transplants shows that a variety of species should be used, as many have antibiotic effects against clostridium. Otherwise, it is likely that Clostridium will develop resistance to probiotics as it has to antibiotics.
Clostridium difficile infection (CDI) has increased to epidemic proportions over the past 15 years, and recurrence rates of 30-65% with failure to respond to multiple courses of antimicrobials are common. The aim of this study was to report the efficacy of fecal microbiota transplantation (FMT) in patients with recurrent CDI in five geographically disparate medical centers across the United States.
A multicenter long-term follow-up study was performed on the use of FMT for recurrent CDI. We were able to contact 77 of 94 eligible patients who had colonoscopic FMT for recurrent CDI ≥ 3 months before. Respondents completed a 36-item questionnaire via mail and/or phone that solicited pre-FMT, post-FMT, and donor data. Study outcomes included primary cure rate (resolution of symptoms without recurrence within 90 days of FMT) and secondary cure rate (resolution of symptoms after one further course of vancomycin with or without repeat FMT).
Seventy-three percent of patients were women and the average age was 65 years. The long-term follow-up period ranged from 3 to 68 months between FMT and data collection (mean: 17 months). The majority of patients were living independently at the time of FMT; however, 40% were ill enough to be hospitalized, homebound, or living in a skilled nursing facility. Spouses and partners accounted for 60% of donors and 27% were either first-degree relatives or otherwise related to the patient. The average symptom duration before FMT was 11 months and patients had failed an average of five conventional antimicrobial regimens; nonetheless, 74% of patients had resolution of their diarrhea in ≤ 3 days. Diarrhea resolved in 82% and improved in 17% of patients within an average of 5 days after FMT. The primary cure rate was 91%. Seven patients either failed to respond or experienced early CDI recurrence (≤ 90 days) after FMT. Four of these patients were successfully treated with vancomycin with or without probiotics; two patients were treated unsuccessfully with vancomycin, but subsequent FMT was successful; one patient was not treated and died in hospice care of unclear cause. The secondary cure rate was 98%. All late recurrences of CDI occurred in the setting of antimicrobial therapy for treatment of infections unrelated to C. difficile. In all, 53% of patients stated they would have FMT as their preferred first treatment option if CDI were to recur. While no definite adverse effects of FMT were noted, two patients had improvement in a pre-existing medical condition and four patients developed diseases of potential interest after FMT.
FMT is a rational, durable, safe, and acceptable treatment option for patients with recurrent CDI.Am J Gastroenterol advance online publication, 27 March 2012; doi:10.1038/ajg.2012.60.
- PMID: 22450732
Division of Pulmonary, Critical Care and Sleep Medicine, Nebraska, USA. firstname.lastname@example.org
PURPOSE OF REVIEW:
Recent clinical trials have furthered our understanding of the role of probiotic and synbiotic therapy across a variety of diverse diseases including antibiotic-associated diarrhea, Clostridium difficile associated diarrhea, acute pancreatitis, ventilator-associated pneumonia, and sepsis among others. Although each of these conditions has implications for critically ill patients, relatively few studies have specifically studied this vulnerable population.
One recent clinical trial studying probiotics in severe pancreatitis (the PROPATRIA trial) found an unexpected increase in mortality in probiotic-treated patients. These results stimulated an immediate, extensive, and badly overdue discussion focused on the need for improved safety monitoring during the execution of all clinical trials using probiotics. However, issues with the design, execution, and analysis of PROPATRIA ultimately created more questions than it answered.
Regardless of technical issues with the study, the increased mortality seen with probiotics cannot be ignored. As a result, various regulatory agencies have clarified their stance on the safety of probiotic research and the legacy of PROPATRIA is increasingly stringent regulation of this fledgling niche.
Microbial Ecology and Health Group, Food Microbial Sciences Unit, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading RG6 6AP, Berkshire, UK. email@example.com
In a study looking at culturable aerobic Actinobacteria associated with the human gastrointestinal tract, the vast majority of isolates obtained from dried human faeces belonged to the genus Bacillus and related bacteria. A total of 124 isolates were recovered from the faeces of 10 healthy adult donors. 16S rRNA gene sequence analyses showed the majority belonged to the families Bacillaceae (n=81) and Paenibacillaceae (n=3), with Bacillus species isolated from all donors. Isolates tentatively identified as Bacillus clausii (n=32) and Bacillus licheniformis (n=28) were recovered most frequently, with the genera Lysinibacillus, Ureibacillus, Oceanobacillus, Ornithinibacillus and Virgibacillus represented in some donors. Phenotypic data confirmed the identities of isolates belonging to well-characterized species. Representatives of the phylum Actinobacteria were recovered in much lower numbers (n=11). Many of the bacilli exhibited antimicrobial activity against one or more strains of Clostridium difficile, Clostridium perfringens, Listeria monocytogenes and Staphylococcus aureus, with some (n=12) found to have no detectable cytopathic effect on HEp-2 cells. This study has revealed greater diversity within gut-associated aerobic spore-formers than previous studies, and suggests that bacilli with potential as probiotics could be isolated from the human gut.
Copyright © 2011 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.
- PMID: 22041546
- A new treatment option for Clostridium difficile: Fecal transplantation (eurekalert.org)
- Man Transplants His Cousin’s Feces Into Himself [Medicine] (gizmodo.com)
- Fecal Transplants: The Straight Poop (scientificamerican.com)
- C. diff patients overcome ‘ick factor’ to embrace therapy (ctv.ca)
- The Species in the Feces (sciencebasedmedicine.org)
- Gut Infections are Killing the Elderly at Frightening Rates | 80beats (blogs.discovermagazine.com)
- 8 Kooky Money-saving, Time-saving, and Health-saving Tips (cherrytart.wordpress.com)
- Enema Transplant Works for Stubborn Infection (nlm.nih.gov)
- How Fecal Transplant Works (5min.com)
- Guest Blogger James T. O’Reilly: Changing The Culture of Those Who Market Probotic Cultures (lawprofessors.typepad.com)