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Poop Transplant Effective Against Deadly Infectious Diarrhea

Deadly infectious diarrhea caused by C. difficile

A poop transplant may be just what the doctor ordered for patients who are faced with a potentially deadly type of infectious diarrhea caused by Clostridium difficile. Results of a new Dutch study have focused attention on this procedure, which has been the topic of other recent research as well. Here are some of the findings.

Donated stool is an effective therapy

C. difficile, often referred to as C. diff, is a bacterium that can cause severe inflammation of the colon, nausea, fever, abdominal pain, and potentially deadly diarrhea. Although C. diff usually affects older adults who are hospitalized or who reside in nursing homes or other long-term care facilities, it can affect anyone and typically develops during or after taking antibiotics.

In the newest study, published in the New England Journal of Medicine, 16 patients underwent a fecal transplant. Thirteen of the patients experienced a resolution of their symptoms after one transplant, while two other patients recovered after a second poop transplant. In comparison, less than one third of individuals who were treated with antibiotics recovered.

According to the authors of another recent study, which was presented at the recent annual Infectious Disease Society of America meeting in San Diego, about 14,000 people in the United States die each year from a C. difficile infection. For individuals who do not respond to antibiotics (e.g., metronidazole, vancomycin) or other treatments, the only options are surgery to remove the infected colon, death, or a poop transplant, known in medical circles as intestinal microbiota transplantation (IMT) or fecal microbiotic transplantation (FMT).

This study involved 49 patients with C. diff infection who received a fecal transplant from a healthy family member. The transplant is prepared by mixing the fecal matter with warm water, and then it is administered via colonoscopy or a nasogastric tube. The procedure can be done either on an inpatient or outpatient basis.

Forty-three of the 49 patients quickly recovered after the transplant and were free of side effects three months after the procedure. Of the six remaining patients, four died of causes unrelated to C. diff diarrhea, one required surgery, and one did not improve.

A fecal transplant introduces healthy bacteria to the patient's intestinal tract, which in turn stimulate the immune system and restore the bacterial balance that is necessary for health. According to the study's senior author, Mayur Ramesh, MD, a Henry Ford Health System infectious diseases physician, "This treatment is a viable option for patients who are not responding to conventional treatment and who want to avoid surgery."

In another recent report, investigators at the University of Utah School of Medicine conducted an analysis of 12 published studies of fecal transplantation. A total of 182 patients were involved: 148 who received the transplant via colonoscopy and 34 who had it delivered via a nasogastric tube.

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The success rate between the two groups was similar: 93.2 percent (138 of 148) in the colonoscopy group and 85.3 percent (29 of 34) in the nasogastric tube group. Recurrence was less than 6 percent in the two groups.

More about C. diff diarrhea
The most common symptoms of mild to moderate C. diff infection are watery diarrhea that occurs three or more time daily for two or more days, mild abdominal tenderness, and cramping. If the condition progresses in severity, colitis develops (inflammation of the colon) along with watery diarrhea (10 to 15 times daily), severe abdominal cramping, loss of appetite, dehydration, pus or blood in the feces, fever, and weight loss.

C. difficile bacteria are ubiquitous in the environment (e.g., air, water, human and animal feces, soil), but they are commonly spread in hospitals and other health care facilities. The bacteria can be easily transmitted by people and on surfaces, and spores from the bacteria can remain viable for months in the environment.

Although healthy individuals often have C. difficile in their intestinal tract, along with beneficial bacteria, use of antibiotics can kill the helpful bacteria, which then opens the door to a C. diff infection. In addition, the Food and Drug Administration issued a warning in early 2012 that use of acid reflux drugs called proton pump inhibitors may increase the risk of C. difficile diarrhea.

Treatment of C. difficile diarrhea usually includes stopping the antibiotic that triggered the infection, but then taking one of two others (metronidazole, vancomycin). Not everyone responds to these drugs, however.

Probiotics also can be helpful in preventing recurrence. About 25 percent of people with C. difficile infection get infected again, sometimes with a different strain of the bacteria.

If you're wondering about receiving the fecal mixture via nasogastric tube, Dr. Ramesh noted that patients who use this method "don't taste or smell the stool mixture as it's administered." Faced with losing one's colon or dying of this deadly form of diarrhea, choosing a poop transplant doesn't seem to be such an unpleasant option.

Henry Ford Health System
Mayo Clinic
Postigo R, Kim JH. Colonoscopic versus nasogastric fecal transplantation for the treatment of Clostridium difficile infection: a review and pooled analysis. Infection 2012 Jul 31
Van Nood E et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. New England Journal of Medicine 2013 Jan 16. DOI:10.1056/NEJMoa1205037

Image: Wikimedia Commons

This article was updated on January 17, 2013