Tuesday, November 1, 2011

'Fecal Transplants' Show Promise for Gastrointestinal Ills

TUESDAY, Nov. 1 (HealthDay News) -- They sound disgusting, but doctors say "fecal transplants" -- once shunned by the medical establishment -- are proving useful against a range of gastrointestinal ailments, new research says.

Presenting at the American College of Gastroenterology annual meeting in Washington, D.C., researchers report that the therapy can ease severe irritable bowel syndrome and nasty bacterial infections.

Fecal microbiota transplant (FMT) involves taking feces from a donor, typically a spouse or relative though it could be anyone, after a light colonoscopy prep.

That sample is then mixed "with some saline so that it's a consistency that can be aspirated into 60 cc syringes," explained Dr. Mark Mellow, one of the researchers presenting findings at the meeting.

The patient then undergoes a routine colonoscopy during which the mixture is inserted. The idea is that this new, transplanted population of healthy flora will correct the patient's underlying problem and it does seem to work.

Some of the most encouraging research comes in the form of three studies which demonstrated the procedure's effectiveness against recalcitrant infection with the bacterium Clostridium difficile. The bug can cause disabling and even life-threatening diarrhea, nausea, vomiting and abdominal pain.

"Patients who have multiple C. difficile recurrences have a totally different population of bacteria that normal people do," said Mellow, who is medical director of the Digestive Health Center at Integris Baptist Medical Center in Oklahoma City. "The key thing is a marked decrease in diversity so, instead of having tons of different strains of microorganisms, they have many less strains and species than many people do."

In Mellow's study, 98 percent of patients with C. difficile who hadn't responded to a mean of five previous treatment courses saw rapid resolution of their symptoms -- if not with the first FMT transplant, then with a second.

The patients had been suffering for a mean of 11 months and many were ill enough to be in acute-care or skilled nursing facilities or homebound, Mellow said.

Dr. David Bernstein, chief of gastroenterology at North Shore University Hospital in Manhasset, N.Y., said: "It seems that this is potentially a phenomenal treatment for C. difficile infection, especially those that are refractory. This works and it's dramatic how quickly it works.

"C. difficile is becoming a greater problem in hospitals, and we're seeing more resistance and morbidity and mortality," he added.

Although it might seem difficult to find a volunteer, Bernstein felt that acceptance among patients would be high because "they've done so much already that has failed. They're desperate."

The transplants would not be first-line treatment for patients, however, Mellow said.

Researchers in Australia also reported success using FMT to treat ulcerative colitis and Crohn's disease in three patients. In all cases, symptoms improved within days or weeks.

Other studies being presented at the meeting found effectiveness with probiotics, live "friendly bacteria" similar to those found naturally in the gut. The idea is similar to an FMT transplant but probiotics are generally sold as dietary supplements or come in foods such as yogurt.

More information

The Mayo Clinic has more on Clostridium difficult.

SOURCES: Mark Mellow, M.D., medical director, Digestive Health Center, Integris Baptist Medical Center, Oklahoma City; David Bernstein, M.D., chief, gastroenterology, North Shore University Hospital, Manhasset, N.Y.; Oct. 31, 2011, presentations, American College of Gastroenterology annual meeting, Washington, D.C.