Fecal Bacteriotherapy
Fecal bacteriotherapy, also known as fecal transplantation or fecal microbiota transplant, is a medical procedure that involves transferring stool from a healthy donor into the gastrointestinal tract of a patient suffering from gastrointestinal tract diseases, primarily Clostridium difficile (C. diff) colitis. This procedure helps restore beneficial bacteria to the patient’s gut, which can be compromised, especially after antibiotic use, allowing harmful bacteria like C. diff to proliferate. C. diff colitis is a serious infection that causes inflammation and severe gastrointestinal symptoms, particularly affecting individuals in healthcare settings.
The history of fecal bacteriotherapy dates back centuries, with various cultures having used similar methods to restore gut health. In the U.S., its use has increased since the 2000s, although it was previously unregulated. The FDA has since established guidelines to ensure safety, reflecting growing recognition of the gut microbiome's role in health. The procedure typically involves thorough preparation, including dietary changes and screening of the donor to ensure a healthy profile. Fecal bacteriotherapy has shown promise not only for C. diff infections but also in research for treating other gastrointestinal disorders, such as ulcerative colitis and Crohn's disease. Despite its effectiveness, it remains less commonly practiced than antibiotic treatments.
Fecal Bacteriotherapy
Fecal bacteriotherapy, which is also called fecal transplantation or fecal microbiota transplant, is a medical procedure that transfers stool from a healthy donor to the gastrointestinal tract of a patient suffering from a gastrointestinal-tract disease—most often Clostridium difficile colitis. The transplant helps recipients because the stool of a healthy donor includes millions of beneficial bacteria. These bacteria populate the gastrointestinal tract of the patient and help limit the number of harmful bacteria such as Clostridium difficile (C. diff).
Clostridium Difficile (C. diff)
Clostridium difficile colitis is inflammation of the large intestine, or colon, caused by the C. diff bacteria. This infection can be spread from person to person, and it most often affects patients in hospitals and nursing homes. C. diff infections are on the rise throughout the world. These infections can range from mild to very severe, with some causing death.
Healthy humans have millions of bacteria in their gastrointestinal tract, and many of these bacteria are beneficial. However, many of these good bacteria can die when people take antibiotics. Sometimes when people are on antibiotics and the good bacteria in the gut die, C. diff bacteria can grow out of control. The C. diff bacteria grow throughout the gastrointestinal tract, and then they release toxins in the body. The toxins cause inflammation, diarrhea, and other adverse effects.
Often, C. diff bacteria are transferred through contact with other people and contact with objects such as door handles, phones, and furniture that have been touched by those who are infected. People who take antibiotics, people who are undergoing chemotherapy, and people who take medicines that reduce stomach acid are more vulnerable to C. diff infections. The best way to avoid transmitting the bacteria and being infected by bacteria that others have spread is by thoroughly washing one’s hands. Because the infection from the bacteria most often occurs after people have been treated by antibiotics and because it is commonly transmitted by healthcare workers, most C. diff infections occur in hospitals and nursing homes.
Since C. diff is bacteria, it is often treated with antibiotics. The most common antibiotic used to treat C. diff is vancomycin; however, new strains of C. diff have become resistant to vancomycin. When bacteria become resistant to antibiotics, they are very difficult to treat. In part because C. diff infections are becoming harder to treat, they kill more than 14,000 people in the United States each year. Since C. diff can be controlled by introducing good bacteria back into the gastrointestinal tract, fecal bacteriotherapy has been one of the most effective treatments for the infection. Despite its high rate of success, bacteriotherapy is not as common as antibiotic treatments.
History of Fecal Bacteriotherapy
Fecal bacteriotherapy has been used for hundreds of years in different forms. Some cultures give very small amounts of mothers’ stool to infants to populate the infants’ gastrointestinal tracts with good bacteria. In the United States, fecal transplantation has been used sporadically since the 1950s.
Although the procedure is still somewhat rare, bacteriotherapy became a more common treatment for C. diff in the United States in the 2000s and 2010s. Before the 2000s, fecal transplantation was mostly unregulated in the United States. In 2013, the Food and Drug Administration (FDA) named the treatment an Investigative New Drug, making it possible for only some doctors to perform the procedure. Doctors and patients petitioned the FDA’s decision, claiming the new classification would make it more difficult for patients to receive the treatment. After the negative reaction, the FDA reversed its decision but placed some restrictions on the procedure to make it safer.
As scientists began to better understand the link between good bacteria and good gut health, scientists began studying bacteriotherapy as a possible treatment for a number of different gastrointestinal diseases. Although fecal transplantation is currently performed mostly for C. diff infections in the United States, researchers began reviewing whether or not fecal bacteriotherapy would be useful for treating other gastrointestinal conditions such as ulcerative colitis, Crohn’s disease, and irritable bowel syndrome. In 2014, the Cleveland Clinic named fecal transplantation one of that year’s top ten medical innovations.
How Fecal Bacteriotherapy Is Performed
Patients undergoing fecal bacteriotherapy have to prepare for the procedure. Patients should prepare by following their doctors’ instructions. They usually prepare by stopping antibiotics a few days before the treatment, by self-administering laxatives and enemas the day before, and by following a liquid diet.
The stool for fecal bacteriotherapy is taken from a healthy donor. Donors for fecal transplantation should not be infected with C. diff, should not have been treated with antibiotics in the past six months, should not have any chronic gastrointestinal disorders, and should not be immunocompromised. Doctors also perform a number of tests to ensure the donor is healthy and is a good candidate for donation. Once a donor is identified, the donor’s stool is collected, mixed with saline, and strained. The strained stool is administered to the patient through a colonoscopy, an endoscopy, or another similar procedure. During the procedure, most patients receive an IV to administer fluids and sedatives.
Although the FDA has regulated fecal transplantation and it should be performed by a physician, some people complete the therapy in their own homes. Physicians recommend against self-administering the treatment in large part because donors cannot be adequately screened for potential diseases and other issues without the help of a physician.
Bibliography
"Clostridium Difficile Colitis—Overview." WebMD. WebMD, Web. 9 Feb. 2016. http://www.webmd.com/digestive-disorders/tc/clostridium-difficile-colitis-overview
Eakin, Emily. "The Excrement Experiment." New Yorker. Condé Nast, 1 Dec. 2014. Web. 9 Feb. 2016. http://www.newyorker.com/magazine/2014/12/01/excrement-experiment
"Fecal Transplant." Cleveland Clinic. Cleveland Clinic, n.d. Web. 9 Feb. 2016. http://my.clevelandclinic.org/services/digestive‗diseases/departments-centers/gastroenterology-hepatology/fecal-transplant
"Fecal Transplantation (Bacteriotherapy)." Johns Hopkins Medicine. Johns Hopkins University, n.d. Web. 9 Feb. 2016. http://www.hopkinsmedicine.org/gastroenterology‗hepatology/clinical‗services/advanced‗endoscopy/fecal‗transplantation.html
"What Is FMT?" Fecal Transplant Foundation. Fecal Transplant Foundation, n.d. Web. 9 Feb. 2016. http://thefecaltransplantfoundation.org/what-is-fecal-transplant/