Fecal Transplant: an introduction...
Fecal transplant. Let face it, the name alone is enough to gross out pretty much anyone. It is, in fact, just what it sounds like: taking feces from a person with healthy intestines and placing it in the colon of the ailing patient. This process puts the "good" bacteria that is normally found in the intestines of a healthy individual into the recipient, whose good bacteria is sparse or even non-existent. This new treatment offers great hope, no ill side effects, a 90%+ success rate, and many patients see improvement after just a few days. Despite the fecal treatment being around since 1958 and building considerable legitimacy from academic research, the FDA has not investigated it as a viable alternative to pills and other medicine. Many times, the culprit is actually the FDA-approved antibiotics that gradually decimates the good bacteria, while creating stronger and more resistant bad bacteria in patients.
What could cause the healthy bacteria to decline in a person? Most sources say it is when a nasty, unhealthy bacteria strain known as Clostridium difficile, or C. diff for short, takes over. Normally the good bacteria maintain a balance with the bad, but this order can become disrupted by the very antibiotics used to treat a C. diff patient. The good bacteria get progressively wiped out with each round of antibiotics and C. diff can then thrive, outnumber the good, and get a stronger hold on the intestines.
C. diff on the rise...
C. diff infection cases have been growing in number during the last 30 years at an alarming rate. They were first thought of as merely a temporary negative side effect to antibiotics but as the bacteria strain has become more resilient to treatments over the years, it is now considered a serious health problem. As the years go by with more and more C. diff strains creating permutations, they've grown stronger and more resistant to medications used to cure them. Remember, the drugs used against C. diff usually kill off the healthy bacteria too. This "screens out" all but the most resistant, hearty C. diff bacteria that reproduce and take over more of the person's intestinal real estate.
According to gastrointerologist and immunologist Alex Khoruts at the University of Minnesota, the fecal transplant bacteria indeed take over the ailing patient's intestines and replace the once-thriving helpful bacteria. Think of it like sending in the healthy bacterial reinforcements to battle it out in the guts. This is enough to swing the advantage back to the good guys and the harmful C. diff is slowly killed off to regain a healthy balance.
When it comes to finding a donor, yes a feces donor, most medical professionals ask their patients to choose one themselves. This could be a brother, sister, child, spouse, or other individual that is willing and has had tests to show they have a healthy gastrointestinal system.
The type of screening needed for a fecal donor is about the same standard as for a blood donation. This ensures they have no digestive diseases or other ailments which would reduce the fecal transplant's success or, worse yet, introduce a new disease to the recipient. The lab work needed is not always covered by insurance and can create other hurdles also with respect to time and medical confidentiality.
Another alternative that has been proposed is to simply have the patients do the fecal transplant in their own home using an enema kit. The downside, as mentioned in Clinical Gastroenterology and Hepatology, is that too much of the transplant "material" may leak out and thereby result in an unsuccessful treatment. Supposedly seven patients have done the do-it-yourself fecal transplant at home safely and had a 100% recovery rate.
Fecal transplants, despite the lack of focused, formal FDA investigation seem to be gaining more popularity as a viable treatment. It has also been recommended that they be tried first in cases of severe C. diff infections as opposed to something to try as a last resort. What is also very thought-provoking is the research on how the intestinal bacteria can influence other health issues such as anxiety, depression, pre-diabetics, and obesity among others. Yes, a poop swap could boost your mood...
Fecal transplants are now undergoing clinical trials not in the United States, but in Canada. The FDA needs those in the medical field who are advocates of this treatment to provide more research and formally file to have this procedure approved. The researchers in the United States express some apprehension about the FDA-approval process, and about being able to answer all the potential questions arising from the proposal. Unlike drug approval petitions, which the FDA commonly deals with, feces is not classified as a drug or other patentable thing. Nevertheless, people are already trying fecal transplants at home to treat their debilitating C. diff infections. Medical providers need to be able to offer this safe, low cost treatment in a professional environment to achieve the best success rates.