By Bret Lashner, MD
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Just the thought of a fecal transplant – of transplanting fecal matter from one person into another – may make a lot of people think, “ick.” It’s an uncomfortable idea.
But consider that a fecal microbiota transplant can help people with stubborn, unhealthy gut flora. These are people struggling with recurring Clostridium difficile infections with longstanding diarrhea and abdominal pain. They can’t go to work or school or really function that well because of how sick they are.
These patients have tried long-term antibiotics, or in some cases, probiotics. But neither of these works very well with stubborn C. difficile infections. Yes, the antibiotics will clear up the infections temporarily, but these patients often experience recurring cycles of antibiotics and infection without any real resolution.
Antibiotics often strip the gut of the good bacteria along with the bad. In these cases, this makes it difficult for the body to keep C. difficile away.
How fecal transplants work
What really works is a fecal microbiota transplant. One theory is that it gives the recipient a boost of healthy bacteria to regenerate his or her own gut flora. This strengthens the person’s gut against future infections, and stops C. difficile from continually gaining a foothold.
After months on antibiotics, it is amazing to see how quickly a fecal transplant can help people. In my practice, I have performed eight of these procedures to date. So far, there has been an excellent success rate and those that respond do so within two weeks. It is a therapy that works.
One patient, upon getting my explanation of the procedure, asked, “Are you serious?” He didn’t want to do it. But most people are very grateful. Patients are sick and donors are very willing to help. It is a procedure that is well-tolerated and low risk. Patients feel normal and they’re very grateful.
Right now, the only patients who are eligible for these fecal microbiota transplants are those with recurrent C. difficile infections. About 20 percent of them recur, and a lot of people come to me after four or five failures with other treatments.
Preparing for the procedure
When patients first come to see me, they also see a financial counselor for approval of the procedure because many insurance companies will not pay for it yet.
Then, the patient and the donor see me together. The donor cannot have any chronic infectious illnesses, like hepatitis, and cannot have been on antibiotics for at least a month. They do not have to be related; they don’t even have to know one another. But most people show up with a relative. We ask donors to sign informed consent and test for communicable diseases they might inadvertently give to the patient. We also test the patient.
How the procedure is done
The day before the procedure, the patient preps for a colonoscopy. The donor takes a laxative to make sure to have a timely and adequate bowel movement the next morning. We ask the donor to mix their stool in a saline solution we provide and ask them to homogenize the stool as much as possible with disposable utensils. Then we ask him or her to filter through a disposable coffee filter, so we are left with only a brown liquid that contains bacteria.
That way, patients arrive for their colonoscopy with a container of the stool fluid. Right before the colonoscopy, we give them Imodium® so they can hold their stool as long as possible. We sedate them very heavily so they will sleep afterward. And then we inject the stool. The longer they hold their bowels, the better the chance for healthy bacteria.
In my experience so far, patients who respond to this treatment feel better within two weeks of this procedure. They are relieved to feel normal again.