Fecal transplant may treat stubborn C. diff

It may sound gross, but using fecal transplants can treat stubborn intestinal infections caused by the bug Clostridium difficile (C. diff).

As the name implies, fecal transplant involves taking the stool of a healthy person and putting it into the colon of an infected person. The goal is to restore the natural balance of good and bad bugs in the gut and eliminate the bothersome diarrhea.

"Ick" factor aside, it works, a new study suggests. "Fecal transplantation is a highly effective, well tolerated, and safe form of therapy for this traditionally difficult infection," study researcher Lawrence Brandt, MD, emeritus, chief of gastroenterology at Montefiore Medical Center, tells WebMD.

His team found that 91% of 77 patients who received the transplants got rid of their diarrhea, sometimes within three days, after one treatment.

The research is being presented at this week's American College of Gastroenterology's annual scientific meeting in Washington, D.C.

The procedure is technically called fecal microbiota therapy (FMT).

About 500,000 people in the U.S. are infected with potentially life-threatening C. diff each year, usually after taking antibiotics, Brandt says. Doctors think the antibiotics upset the natural gut balance and trigger the C. diff growth.

Many patients are elderly and in hospitals or nursing homes. C. diff live on bathroom fixtures and medical equipment. The bacteria can be spread person to person from contaminated hospital equipment or from the hands of health care providers.

However, recent research finds that hospital-acquired C. diff has leveled off while C. diff in the community is on the rise. For some, the typical round of antibiotics targeted to treat the C. diff infection does not provide relief. Or, it provides short-term relief and the infection returns.

Tracking Results of FMT

Brandt and his colleagues tracked down 77 C. diff patients -- 56 women and 21 men -- who had FMT done at least three months before at five different centers. The average follow-up time was 17 months and ranged from three months to more than five years.

Their average age was 65.

The patients had had the infection an average of 11 months before undergoing the FMT. They had, on average, taken five courses of antibiotics or other treatments without relief.

Many reported severe fatigue, 20-pound weight loss, and more than six bouts of diarrhea a day.

The FMT was done by colonoscopy (insertion of a lighted flexible tube into the colon), a common method, Brandt says.

After the fecal transplant procedure, patients answered a detailed questionnaire. The results:

• *At the three-month mark, 70 of 77 patients (91%) reported no diarrhea, considered a treatment success.
• *Another four recovered after an additional course of antibiotics.
• *Another two recovered after receiving both more antibiotics and another fecal transplant. That brought the total success rate to 76 of 77. The other patient, in hospice care, died.
• *Diarrhea resolved on average in six days, sometimes as quickly as in three. Fatigue went away in about a month.

No complications or side effects were reported. The cost of the procedure, which is currently done by a limited number of doctors, is often less than what several rounds of expensive antibiotics could cost, Brandt tells WebMD.

For the FMT, the main charge is the cost of the colonoscopy, which is often covered or partially covered by insurance. Colonoscopy can cost several hundred dollars or more. Among possible complications are tearing of the colon.

Brandt reports serving as a consultant for Optimer Pharmaceuticals, which makes fidaxomicin (Dificid), a C. diff treatment.

FMT Basics

FMT is not new. The first successful use was reported in 1958, with a transplant done by enema. In the U.S., the first case of FMT done by colonoscopy was reported in 2000.

Researchers try to get a stool sample from someone close to the patient, such as a spouse. They believe the healthy person will have exposure to some of the same bacteria, living in the same environment, so their stool will be a good match.

Before transplant, the donor's sample is screened for hepatitis, HIV, and syphilis, Brandt says.

Second Opinion

Martin H. Floch, MD, MS, clinical professor of medicine at Yale University, says that the process is simple. He reviewed the study findings for WebMD.

Although the new study reported no complications, Floch says it is possible some could develop later.

He cautions that the donor stool must be thoroughly screened to avoid disease transmission.

Overall, however, he considers the results good news. The 91% success rate, he says, is ''terrific. Nine out of 10 people doing this succeed, and remember these are resistant cases."

Although more study is needed, he says FMT should be viewed as a successful therapy for stubborn cases when medications don't work.

This study was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.