Fecal Transplant Roundup

A new study has found that fecal transplants work better than antibiotics for clearing up a common and dangerous infection:

Such transplants cured 15 of 16 people who had recurring [= difficult-to-get-rid-of] infections with Clostridium difficile bacteria, whereas antibiotics cured only 3 of 13 and 4 of 13 patients in two comparison groups.

Clostridium difficile infections often result from antibiotic treatment. It is a big step forward for modern medicine to manage to grasp that the bacteria in our bodies protect us from infection. Here is a blog about the value of fecal transplants; here is another blog.

The comments contain many interesting details:

I spent Thanksgiving of 2012 in ICU and almost died from C-Diff. It was a harrowing experience for both me and my family. It required two months of care, recuperation and doses of vancomycin. My hospital bills are outrageous. [Fecal transplants are much cheaper -- Seth] I am praying it doesn’t return, having just finished my last dose of vancomycin. I had a dental implant and was on clyndamycin for two weeks and that was the culprit. Dentists should be required to inform patients that C-Diff could be a reaction to that specific antibiotic. I was not warned about this being a possible side effect.

Our mother was hospitalized at a major university hospital and came down with C. diff. The antibiotics they gave her to fight the infection finally destroyed her kidneys and hearing and she decided that life was not worth living in that condition.

We have using this “treatment” for years and years in horses with difficult intestinal issues which didn’t respond to other medications. We pass a slurry of fecal material from a heathy horse ( often mixed with electrolytes and baking soda) directly into the stomach of the sick horse. It works in almost all cases.

After my gut microflora was destroyed by 9 months of antibiotics for Lyme disease, I got C. diff this past June. Was flabbergasted that NONE of my doctors, ALL of whom prescribe antibiotics, ( & hopefully read the NYT or the INTERNET) [knew] about fecal transplants! I ditched my Lyme doctor (who said along with my GI & GP): “Take Flagyll” (which didn’t work) and then Vancomycin. No thanks. Wasn’t going to wait around for the C. diff to corrode my guts or till I was almost dead, so I went right to Dr. Brandt for a transplant and in ONE day the symptoms were gone.

I had recurring c diff for 12 months.Tried a myriad of antibiotics and a colon cleanse.Nothing worked. I was getting sicker and weaker by the day, not to mention very depressed. I was “beyond” desperate. My husband (an internist) performed a fecal transplant (using my brothers stool–close DNA donor) at home (hanging the saline/stool bag from the ceiling fan!) 3+ years ago. I have been healthy ever since.

[A doctor:]  This important study . . . is a big step in the right direction, however the study is quite small. [A doctor who doesn't understand statistics even after it is explained in plain English. The evidence from this "small" study is very strong. In case you didn't understand the numbers, the article says it in words: "the antibiotic groups were faring so poorly compared with the transplant patients that it was considered unethical to continue". -- Seth] A larger RCT is needed before this becomes standard of care [implying that his or her lack of understanding of statistics is the norm -- Seth]. Since no one is currently in position to reap monopoly profits from this treatment, I predict the study will be a long time coming. [Which, if true, implies that doctors' lack of understanding of statistics will kill a lot of people.--Seth]

The majority of cases of C. difficile infection occur in the hospital where they were usually brought on by use of broad-spectrum antibiotics destroying the natural balance of intestinal flora in the gut. A great many people outside the hospital setting walk around healthy colonized by C. difficile without becoming infected. Others become colonized while in the hospital, a virtual surety if you stay long enough. Broad-spectrum antibiotics wipe out bacteria that normally out-compete C. difficile at different niches within the intestinal ecosystem. [In other words, gross overuse of antibiotics has created a new ecosystem -- modern hospitals -- where C. difficile thrives. -- Seth]

After a reaction to an antibiotic caused C Diff which lasted almost a year, was treated with multiple antibiotics of which Vancomycin was the only one that kept it at bay, having had a number of courses without success, meanwhile weight was down 25 lbs and health was deteriorating as in my opinion Vancomycin also presented some problems of its own, teeth browning, lethargy etc. C Diff ruins body and soul. After a lot of research was lucky to have found a doctor who checked out the fecal transplant history/procedure and performed the transplant. The feces donor was my brother having first had blood & feces testing. The transplant was a success, after suffering C Diff for almost a year my quality of life is great – normal.

The [squeamish] tone of this article is enraging. [It begins "The treatment may sound appalling". The headline calls it "This, er, Option". -- Seth] I contracted ulcerative colitis when I was fifteen, and the squeamishness of my parents and doctors in my small town prevented me from accessing real care. More concerned with being grossed out than dealing with the problem at hand, I was allowed to go a year without receiving proper care. As a result, I ended up with such extreme internal bleeding that I was sent unconscious to the intensive care unit at Swedish Hospital in Seattle, three hours away from home, where a surgeon removed my entire colon. He chided my parents and local doctors for not seeking help from a specialist sooner; had they done so, I would not have been in such dire condition. I spent the next year of my childhood in the hospital. All this is to say: get over feeling grossed out by the human body and consider any possible treatments that might work. If this one does, great. Ditch the whole “ew” reaction because it stands in the way of saving lives.

I was plagued for decades with room-clearing gas and stomach cramps. Yogurt and probiotics didn’t stand a chance against the established bad bugs. Then I went for my first colonoscopy (which gave me a whistle-clean gut.) I was told I could have anything I wanted. First thing, I drank a full quart of organic kefir. I haven’t had a problem since. [Very interesting. Before a colonoscopy, you take something special to clean out your gut.--Seth]

Thanks to Alex Blackwood and Karen Goeders.

12 Responses to “Fecal Transplant Roundup”

  1. derp Says:

    The doctor you cited indeed is not familiar with statistics. Though he is right that the sample size is small, the effect is large. Furthermore, he seems to have no clue regarding previous studies. Showing the same effect over and over again creates a different statistic – you cannot simply view one study in isolation. This has been repeatedly critized and led to statisticians proposing non-frequentist (read: Bayesian) statistics for medical research (cf. Goodman, Ann. Intern Med. 1999;130(12):1005-1013). Even when using a pooled analysis (Gough et al., Clin Infect Dis. 2011;53(10):994-1002), the treatment effect is so large that instead of arguing, it calls for immediate development of treatment protocols (i.e. donor eligibility, disease screening of the donor, amount & frequency & mode of delivery of the transplant, …).

    Seth: Good point.

  2. Jazi Zilber Says:

    FDA is already blocking innovation here

    They want to disallow it until fully controlled by them.

    Likewise, FDA fight AGAINST smokeless cigarettes. Unbelievable!
    We have a certain killer cigarettes. We have a seemingly safe alternative – synthetic cigarettes. Yet it is “not approved here” and FDA fight against it!

  3. John Eels Says:

    I can’t resist but ask a very practical/utilitarian question. What would you advice a friend to do if he suffered from SIBO (small intestinal bacterial overgrowth)?

    Seth: I don’t know.

  4. Jonathan Says:

    The horse tale is particularly interesting. It implies that a fecal transplant can be done via the stomach. Perhaps, if a sufferer can’t find proper medical transplant, in an emergency they might be able to self-treat by eating feces?

    Seth: Good point. One person uses ice cubes. Which she swallows.

  5. Adam Says:

    Of course the FDA is blocking innovation. That is pretty much just what they do. It makes sense when you discover that they are largely funded by the pharmaceutical companies.

  6. dearieme Says:

    I was about to raise the issue of repugnance, but probably some people wouldn’t give a s…

  7. Paul N Says:

    An alternative – and perhaps less “icky” means to the fecal transplant, is a microbiota transplant by inserting kefir grains into the colon – seems to have the same effect, at least in the case described here;

    How I corrected ulcerative colitis with kefir grains

    This and the kefir example in the story above suggest that feces aren’t the only way to do this. Part of the problem is likely that many probiotics don’t survive the stomach/small intestine, so placing them directly in the colon gets around this.

  8. Howard Lundy Says:

    Good roundup…A fecal transplant (FT) pretty much saved my uncle’s life. He had the C. diff colitis infection and was in progressive decline. About 3 days after the FT he started feeling normal again…. get the word out!
     
    Visit my advocacy blog for more information at http://fecaltransplant.info

    or www [dot] fecaltransplant [dot] info

  9. dearieme Says:

    Ahoy, Seth:
    http://www.guardian.co.uk/lifeandstyle/2013/jan/19/what-doctors-wont-do

  10. Michael Says:

    Thank you for referencing my website FecalTransplant.org. A quick note I wanted to make was that I used Fecal Transplant to cure myself of Ulcerative Colitis, which was not caused by Clostridium Difficile bacteria.

    Most of the studies that are now making headlines in the United States are for its application for c. diff bacteria, however its uses go far beyond just that bacterial infection, but also to diseases like Ulcerative Colitis or Crohn’s Disease that are not recognized as being caused by bacterial infection by doctors in the U.S. It is my belief that many disease currently known as autoimmune disorders are actually caused by infection by an unknown pathogen.

    Seth: That’s an interesting idea. Is there evidence for it? I might put it differently. That many diseases are caused by UNDERINFECTION, a new concept to many doctors.

  11. Lemmy Caution Says:

    Fecal transplants seem like a good idea. I would like to know how dangerous the procedure is though.

  12. Teri Says:

    A fecal transplant healed me from coliltis in October 2012 after 3 1/2 years of suffering.

    Read my blog -http://healed-from-uc.blogspot.com

    It WORKS!

    I am symptom free and drug free!!!