According to Health Canada, Clostridium difficile is the leading cause of infectious diarrhea in Canadian hospitals and long-term health facilities. And 1 in 10 patients who contract the infection will die from it. In January of this year, a landmark study from the New England Journal of Medicine showed that fecal transplants were by far the best way of curing persistent intestinal infections caused by C. difficile. In a fecal transplant the stool of a healthy person is put it into the digestive tract of an infected individual. That’s right. Fecal. Transplant.
Although this procedure has been performed for years, this is the first time a randomized controlled trial comparing fecal transplants to antibiotics has been done.
In this study, the participants who received the transplants had a cure rate of 94% compared to only 31% in those who received the antibiotic vancomycin, and 23% for a third group who received a bowel lavage followed by vancomycin. The results were so conclusive, the researchers actually had to stop the trial early because the monitoring board overseeing the trial determined that it was not ethical to withhold the transplants from the other participants.
To do this procedure, a healthy donor’s stool is screened for infectious organisms like parasites, then blended, mixed with salt water, and pumped into the gut via an enema or, as in this study, through a nasal tube snaked down into the intestines. The theory is that the bacteria in the healthy gut are used to repopulate the normal mix of bacteria in the person infected with C. difficile and crowd out the disease-causing agent.
But…you may wonder…could we not just give probiotic supplements to the patients and skip the (icky) poop-through-the-nose-tube part? Possibly. Only weeks ago, Health Canada approved Bio-K, a Canadian-made fermented milk-based probiotic product, as an effective means of preventing C. difficile. A study published in 2010 in the American Journal of Gastroenterology showed a 95% drop in the number of patients who contracted Clostridium difficile after being given two dose of Bio-K. More studies can determine whether Bio-K could be as effective in curing C. difficile as it is in preventing it.
So far, fecal transplants are a “niche” procedure, not widely performed by physicians. The procedure has been used on an “ad hoc basis” for 50 years and has always performed well in studies (although this recent study is seemingly the best designed). One professor at the University of Calgary, Dr. Tom Louie, has done more than 100 fecal transplants and looks favourably on the new study: “Overall I think this paper is an important paper to say that performing fecal transplants does work.”
If we’ve known for years that the procedure works, why hasn’t it been used more? Maryn McKenna wrote a well publicized article about the fecal transplants for Scientific American over a year ago. Since then she has received more than 100 emails from patients with C. difficile who want to try the procedure but cannot find a doctor who agrees that “the procedure has merit”. McKenna speculates that doctors’ distaste for the procedure is the main barrier to it’s wider use. And, because feces is decidedly unpatentable, big pharma have not stepped in to give the procedure the push it needs.
Let’s hope that this new study gives fecal transplants more attention and that public pressure can make the procedure more widely available. This would prevent much human suffering and needless deaths – which should be the goal of any good health care system, shouldn’t it?
(*whereas I’d love to take credit for the term “rePOOPulate”, alas, this Canadian group of doctors beat me to it)