February 20th, 2012
Fecal transplants: The new cure-all?
The importance of our normal gut flora becomes apparent when antibiotics wipe out a portion of it and give Clostridium difficile a niche to reside in, which can lead to severe colitis. Relapse of the colitis is the rule until the normal gut flora is reestablished, and treatment of relapsing C. difficile colitis has usually involved trials of antibiotics and toxin binding agents.
More recently, fecal transplants have been reported as both first-line and relapse treatment for C. diff. The effect seems to be far superior to that from traditional approaches and is being touted as a treatment for other GI and nonGI diseases as well.
Have you used fecal transplants?
If not, what would it take for you to start using them?
If yes, how do you a) prepare them and b) deliver them (e.g., through the scope or by oral capsule delivery)?
What diseases do you screen the donor for?
What success rate have you observed?
How much does the treatment cost?
I look forward to hearing what your experiences have been.
2 Responses to “Fecal transplants: The new cure-all?”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
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I’ve used fecal transplants with half a dozen patients, delivered via enema.
One case of “post C. diff” diarrhea (tested positive in past, now tests negative but with same symptoms), with immediate, dramatic effect
Three cases of UC with significant improvement
Two cases of IBS with no clear benefit
Donor testing:
Serum: HIV, syphilis, acute viral hepatitis panel, Lyme disease
Stool: O&P, C diff, enteric pathogens, giardia, cyptosporidium, isospora, cyclospora
History and PE to R/O autoimmune disease, atopic disease, mood and metabolic disorders, chronic pain,and any history of GI disturbance.
No hx of antibiotic use in past 6 months
Donors can waive screening of related (child, parent, spouse) donor, and self-prepare and administer the slurry in which case the tx is virtually free. Using our donor bank and having our lab prepare the fecal slurry is about $3,000 for ten consecutive days.
Greetings Brian!
This is something that has been talked about for decades, back when we were in training. I have used it one time more than 20 yrs ago in a young woman who developed severe c diff colitis as an inpatient after gyn surgery- failed combo iv flagyl and po vanc. Her colon was dilating, surgery wanted to operate, she refused. Mixed a stool specimen from a family friend who had not been in contact with her with saline and delivered as far as I could reach with an egd scope. She got better. n of 1. did no testing of donor stool, just verified her health and her lack of any contact with the patient or her husband. Prior to recent articles would probably have to jump through many hoops to do this
William Schindler D.O., FACG, FACP