Would You Try This Strange New Treatment for Serious Diarrhea?

Fecal microbiota transplantation: how it works

When you have diarrhea that won’t go away, you’ll do anything to get rid of it. That’s why patients and physicians are eager to know more about a treatment called fecal microbiota transplantation (FMT). It works — and fast.

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“We see dramatic improvement from day one to day three. It changes patients’ lives,” says Cleveland Clinic Florida gastroenterologist Alison Schneider, MD

Beyond the ‘yuk’ factor

Although FMT has a high “yuk” factor, there really isn’t anything icky about it.

A mixture of stool from a healthy donor is simply transferred into the patient’s colon during a colonoscopy. The healthy flora immediately take over and start breaking down food properly, making nice, firm stools.

For most people, one treatment takes care of the problem indefinitely.

Keeping patients safe

Screening fecal donors protects recipients. It’s important to only take stool from those free from any disease that might affect their gut flora.  “We want the healthiest donor possible,” says Dr. Schneider.

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Because the biologic therapy is safe, it can be used to restore quality of life for patients who contracted the bacterial infection for any reason.

An effective last resort

At this time, the Food and Drug Administration (FDA) only allows FMT to be used on patients with recurrent or unresolved diarrhea caused by C difficile infection. When antibiotic therapy fails to eradicate the bacteria, and probiotics and anti-diarrheal medications don’t manage the diarrhea, FMT is the sole option.

About 150 patients have undergone FMT at Cleveland Clinic with no side effects or bad reactions. The cure rate is 95 percent.

In 5 percent, the treatment has eliminated the C diff, but not the diarrhea. “In these cases, the diarrhea is likely due to ulcerative colitis or other cause,” says gastroenterologist Bret Lashner, MD, who performs FMT on Cleveland Clinic’s main campus.

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The good news is that FMT can be performed more than once if necessary. One Cleveland Clinic patient became reinfected with C diff during hospitalization for an unrelated medical problem and successfully underwent FMT again a second time.

What the future holds

With all these advantages and no apparent drawbacks, the gastroenterologists are gung-ho about FMT. Multiple clinical trials of FMT for ulcerative colitis, inflammatory bowel disease, diabetes, coronary artery disease and other conditions are being conducted worldwide.

Until the FDA allows it to be used for these conditions, however, only C diff patients can benefit.

“FMT is a good concept. We do it well, and our patients get better,” says Dr. Schneider.

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