What Is Fecal Transplantation And When Is It Recommended?
Fecal transplantation or bacteriotherapy is an experimental treatment that raises much controversy. It consists of transferring the intestinal microbiome from a healthy donor to patients suffering from a variety of diseases associated with alterations in colonic microbes. Yes, you got it right. It involves ingesting a portion of the stool of a healthy donor.
Clostridum difficile infection : a success story of fecal transplantation
Clostridium difficile (C. diff) is a bacteria that lives in our environment. Many people have C. diff in their bodies without a problem. It is known that it is not the bacteria itself that causes disease.
Only under certain conditions do the bacteria release toxins, which is what causes the disease. A person with C. diff infection may experience diarrhea and abdominal cramps. In severe cases, the infection can cause dehydration, require hospitalization, and be life-threatening.
In 2018, approximately 10,000 patients received fecal transplantation in the United States. The treatment is not new. In fact, there is a clinical practice guide that regulates it since 2013. Its application is indicated for patients infected with “recurrent or refractory” C. diff. This means that you get the infection repeatedly and do not respond to antibiotics. In addition, the application for new cases, in adults and children, has been allowed since 2018.
The application of fecal transplantation for any disease other than C. diff infection can only be done in the context of a clinical trial.
How is a fecal transplant performed?
There are several ways to administer this treatment. The most common is through a colonoscopy obtaining a donation from a stool bank. This procedure is very safe in general; only mild discomforts, such as bloating, gas, and low-grade fevers have been reported.
Stool comes from a stool bank, which operates in a similar way to tissue banks. First, the donor’s stool is examined for potentially disease-causing organisms. Also, donor blood undergoes routine laboratory tests to rule out infectious diseases. Thus, the stool bank provides optimal material for transplantation.
Another option is for the doctor to perform the procedure with donors who are friends or relatives of the patients. This is an exception that allows physicians to use their experience and judgment.
The third way is through ‘stool-based products’. These would be pills or delivery systems that offer, for example, a combination of microbes, rather than the entire universe of microorganisms.
How well does transplantation work for Clostridium infection ?
Each year, there are more than 450,000 cases in the United States; deaths exceed 29 thousand people. Of these, 20% of patients do not cure due to antibiotic treatment and the infection returns again and again and again.
In these patients, including pediatric cases, fecal transplantation has a cure rate of 80 to 90%, which means that the vast majority will be cured of the recurrent infection with a single treatment. However, there are some patients who will need more than one transplant.
What are the possible complications of this treatment?
Overall, it is a safe, well-tolerated, and life-saving procedure. Importantly, it should not be attempted at home; it should only be performed by a trained physician, using carefully examined material.
Unfortunately, fecal transplants come with a dose of danger. Stool is a mixture of our undigested waste and the repertoire of beneficial microbes that will establish a new order in the intestinal ecosystem. However, it will also possess ‘less friendly’ or potentially pathogenic bacteria, fungi and viruses.
Fecal transplantation in the treatment of other diseases
This procedure is used with relative success in conditions such as diabetes. In pediatric patients it has been used for inflammatory bowel disease. In clinical trials it has been used in end-stage liver disease, Alzheimer’s, multiple sclerosis, various cancers, asthma, allergies, and heart disease.
All these diseases have been associated with alterations in the bacteria that make up our intestinal ecosystem.
The existence of stool super donors
The finding of super donors has been surprising: people whose stools achieve a success rate, perhaps twice the average, in the clinical improvement of the patient under treatment.
