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Fecal Transplant Restores Gut Flora

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Q. Many years ago, I developed a terrible Clostridium difficile (C diff) infection in my gut from antibiotic treatment for Chlamydia. Vancomycin did not cure the C diff, which was painful.

My elderly gastroenterologist remembered that it used to be common to give people "flora restoration" for this condition, washing out the harmful bacteria by enema and replacing it by flora taken from a healthy individual. A nurse friend of mine organized such a transfer. My pain disappeared completely.

At that time, I corresponded with Dr. Borody, a gastroenterologist in Sydney, Australia, and he now provides the transfer treatment there. I understand that the Swedes never dropped this form of treatment.

A. C diff infections are becoming harder and harder to treat. When antibiotics wipe out good bacteria in the digestive tract, C diff often takes over. It can cause serious or even life-threatening diarrhea.

A recent article in the journal Clinical Gastroenterology and Hepatology (online Aug. 24, 2011) described fecal microbiota transplant as "safe, inexpensive, and effective." By re-introducing normal intestinal bacteria, the balance can be re-established.

This "poop transplant" can be done by way of a colonoscopy or an enema using bacteria from a healthy donor. The authors report that such transfers are successful in treating C diff more than 90 percent of the time. They suggest considering this treatment for C diff infections that have not responded to other treatments.

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17 Comments

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I would think there is great risk of transmission of harmful infective agents in this therapy. How was the patient's risk of acquiring harmful microbes avoided?

One of the GI surgeons in the hospital where I work is about to begin a trial of this therapy. I wonder what would be the comparison to using a probiotic strategy of Lactobacillus rhamnosus, Bifidobacterium species, or Saccharomyces boulardii. Or better, a combination of these.

This was interesting to read. My sister has been on antibiotics on and off for past couple of years. It was to kill a parasite type infection I believe in her intestines. I told her to take a quality probiotics to get balance back. She has been suffering from diarrhea again and doctors cant seem to find out what is wrong. She recently went for colonoscopy but they found nothing.

This is an interesting procedure. Any further reasons like hers to maybe seek this treatment?

My wife had one of those infections and as she slowly recovered the doctor prescribed florastor, an over the counter good bacteria treatment. It has apparently helped as she is no longer laid up with the problem. No colonoscopy nor enemas to contend with.

You know, I think that the bacteria in yogurts etc are just the tip of the iceberg when it comes to what is living on us, in us or in our gut. There is a new DNA technique that looks at the remnant DNA for bacteria and it showed that we didn't know half of the bacteria that was on our skin. In fact it was so specific that it showed there were different suites of bacteria for very small patches of skin. I imagine a similar technique might be used for gut bacteria as well. Hopefully researchers will use this process to help develop a broad understanding of what is living on us and in us.

•Lactobacillus rhamnosus GG- like in Culturelle uses good bacteria from healthy people' stools. My husband was very sick with a clostridium difficile infection after intestinal surgery and was given flagil. We were afraid the infection would return if he needed antibiotics again. His brother in Norway told us about something similar to culturelle that is available in Norway and it was very good.

Also, my sister in Brazil had used something similar to Culturelle for an intestinal infection and recommended it. She also told me about "poop" transplant. At that time it was very difficult to get some culturelle, we had to order it from Boston. When I told the doctor about culturelle and "poop" transplant, he told me that it was disgusting and please do not take anything like that. Well, I always have some culturelle in my fridge.

My girlfriend who has been treated for 6 monthes with c-diff, was hospitalized 10 days in Jan. and is on Vancomycin 500 mg. qid now and still does not get rid of the spores, which is the problem. The antibiotic will get rid of the bacteria but the spores keep popping up.

She is on a new antibiotic which is called dificid. It is very expensive but she is part of a clincal trial.Our scientists need to find something for this difficult condition. It is running wild.

I'm curious. As I've been taking probiotics for almost two years and have enjoyed a mostly great digestive system and very stable bowel movements, if I happened to get this infection, would it also cause me serious problems? Due to my age and taking Enbrel for psoriasis and arthritis, I have a reduced immune system. I don't know how I would get this infection, but I suppose nowadays, anything is possible.

In response to a couple of already posted comments: All newborn babies have their intestinal tracts, sterile before birth, populated by bacteria from the intestinal tracts of whatever people who handle them in the first few days of life, and they almost universally do fine; I would doubt, therefore, that there is any "great risk" of transmission of "harmful infective bacteria" by stool transplant preparations from healthy donors. I would, however, think that a stool culture to screen for major pathogens would be wise.

I have used "good bacteria" preparations (e.g. Culturelle) and "good yeast" preparations (e.g. Florastor) given by mouth to treat a variety of diarrheas in my patients with considerable success over the years. However, in a severe case of C. difficile I can see that the "poop transplant" could offer a couple of advantages. The "washout" prior to the transplantation would greatly lessen the burden of C. diff in the intestine; and the introduction of a tried-and-proven-healthy mix of bowel flora via enema or colonoscopy would bypass the damage to and killing of some of the desirable organisms by exposure to hydrochloric stomach acid.

there's a phase II trial that is similar to what they are doing here. It is safer because they eliminate the uncertainty of bad virus and bacteria that can be transferred from a donor. check it out.

the company uses non-toxigenic c-diff.

http://clinicaltrials.gov/ct2/show/NCT01259726?term=viropharma&rank=2

I am interested in the article in Clinical Gastroenterology & Hepatology regarding micrbiota transplant for Rx of C Difficile infection. Can you supply the exact author/title/reference?
Thanks for your work,
D Fisher

PEOPLE'S PHARMACY RESPONSE: HERE'S THE ABSTRACT:

Clin Gastroenterol Hepatol. 2011 Aug 24. [Epub ahead of print]
Treating Clostridium difficile Infection With Fecal Microbiota Transplantation.
Fecal Microbiota Transplantation Workgroup.
Abstract
Clostridium difficile infection is increasing in incidence, severity, and mortality. Treatment options are limited and appear to be losing efficacy. Recurrent disease is especially challenging; extended treatment with oral vancomycin is becoming increasingly common but is expensive. Fecal microbiota transplantation is safe, inexpensive, and effective; according to case and small series reports, about 90% of patients are cured. We discuss the rationale, methods, and use of fecal microbiota transplantation.

Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

Please be aware of taking probiotics when you take antibiotics. Probiotics helped my husband's "gut" to heal when he got a case of C-Diff which he got while in hospital. Prior to that, he had been on many rounds of antibiotics for diverticulitis, then had surgery. Anyway, just be sure to take probiotics when you're doing antibiotics.

If you ask your doctor about taking them, however, I bet he/she will not encourage you to take them! Please research probiotics---manage your health along with your doctor. Finally, just eating yogurt is not enough, though helpful. You need to go to the refrigerated section of health food store for probiotics. Keep them in your fridge. I don't reserve taking them for only if I've taken antibiotics which is rare, if ever, thank goodness.

According to my research, probiotics should be taken daily. The "Cadillac" of probiotics is considered to be acidophilus. And... wash your hands a lot with regular soap and warm water! As many articles will tell you, this is one of the best defenses against illness. Always wash your hands when you come home from being in public. Eeeuuuu....some viruses can live for days on surfaces. True!

Thank you for this information. My husband is ill with c diff infection at present. I am capable of doing the procedure at home myself, after 50 yrs of being a practicing RN. I am just trying to find best procedure. He is under Hospice care because of 45lb + wt loss and severe anorexia. We refused peg tube. It has only been happening for 6 mos now It happened because of a foot infection which lead to leg amputation and of course numerous IV antibiotics.

I recently performed a FMT for a client that I was doing home care for. Her GI doctor had recommended it . He was unable to perform the procedure at the health organization that he worked for. He had specific and safe directions to follow to insure a successful process. I also did extensive research to insure a successful outcome. I think the cost factor has steered people in this direction.

I charged $500.00 . This included a consult, help with assembling equipment, support during and after procedure and also attending follow up visit with GI doctor. I live in Minnesota and do not know of many places that offer this option. We used a standard colonoscopy prep and administered the donor (her husband) stool as a standard enema.

She and her husband chose to forego the testing for diseases or illness. This saved them thousands of dollars. Of course they were aware of her husband's complete medical history. I am hoping to continue to help people recover from c-dif by using this procedure. I am looking for a means of communication that would connect these ill patients with myself.

Is this a one time treatment? I read Dr. Borody's protocol and it says 5-10 are recommended? How soon can procedure be done? My sister took flagyl. Then vanco. Then a combo of both. Then a vanco taper. Nothing worked.

She has been off the meds for 3 weeks and really needs help. Her Doctor was appalled by the proceudre and said she needs to try the meds again. The Borody protocol gives all details, in which it says that the antibiotics need to be taking for 10-14 days before doing the procedure. I don't understand this part. Can you help us at all?

I suffered with cdiff that was not fazed by flagyl or vanco. My insurance company spent thousands of dollars on medications for my cdiff but still it came back immediately after I stopped using the meds. I wound up in the hospital and a gastroenterologist was brought in. He tried more vanco and flagyl, then said that since I was in need of a colonscopy screen since I was 50 that he would do a fecal transplant at the same time.

My husband was the donor and his blood and stool was tested for multiple things to make sure he was not giving me something bad. The day of the colonscopy came and I never had diarrhea again. Not a watery stool, nothing!!!! I felt it was miraculous and would do it again before I try any medication.

I am just wondering that since I now have my husbands flora in my colon should I still shy away from antibiotics for other thing. I think I have strep throat but am afraid to find out since I don't want to go on antibiotics in fear of cdiff.

I have had my 4th relapse with c-diff,am about at witts end.Can I ask you which Dr. did yours and where?Thanks for your help!

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