Effective treatment for c-Diff infections

If you know someone who has been infected with C-diff, you know how hard it is to treat.  I have learned about a drug-less treatment that is actually a cure for c-diff infections and also is used to effectively treat a whole variety of gut-related diseases.  The reason you may not heave heard of it because of the yucky factor.
                                       
History
More than 20 years ago, physicians began to experiment with treating various forms of IBD with transplanted fecal matter.  Although this is difficult to discuss with a straight face and invariably conjures up a few humorous names, it really has been shown to be an effective treatment.  Getting it to be socially acceptable is another matter.

FMT has been used for years in animal husbandry to treat various infections in animals  Starting in 1958, Eiseman experimented with human patients.  But with the advent of antibiotics, the treatment modality shifted to those drugs because they were much easier to administer, although not necessarily more effective.

The Process
In its simplest form, the technique involves collecting a stool sample from a healthy donor, combining it in a blender with normal saline solution, filtering it, loading the resulting solution in an enema bottle or bag and then infusing it into the patient’s rectum.   This takes a special kind of spouse or caretaker.

Each time the treatment takes place, a new donor stool sample must be taken, since the bacteria are anerobic and do not live long outside the gut.

Earlier experiments with FMT involved introducing the fecal transplant by nasogastric tube.  Although that method has the advantage of being able to distribute the transplanted microbiota throughout the gut, it is uncomfortable, invasive and carries risks.   Further, depositing the donor fecal matter in the stomach subjects its bacteria to stomach acid, which may kill the majority of them even before they reach the small intestine. 

Some physicians are using a colonoscope for the initial treatment to give the donor bacteria the best chance of wide distribution throughout the colon and hence success.  However, it is invasive and carries the risk of perforation.

It is hard to believe that the transplanted fecal bacteria in a small-dosage enema, such as that administered in a small plastic disposable bottle, would be able to flow upstream so to speak, against the gut’s peristalsis and thus distribute itself throughout the gut.  But it does.

Preparation
Before proceeding, the donor should have various stool tests performed to confirm that there are no pathogens or parasites.  Some of these pathogens that have been mentioned in the articles below are: hepatitis A, B & C, cytomegalovirus, Esptein-Barr virus; aeromonas, campylobacter jejuni, C. difficile, plesiomonas, salmonella, shigella and yersinia bacteria.

In the past, experimenters killed all the patient’s existing gut bacteria with a cocktail of antibiotics and then execute the same kind of colon lavage that one would use for a colonoscopy.  More recently, the first step is being skipped without affecting the result.

Home Administration
Also in recent years, the treatment is being carried out at home under a protocol developed by the experimenters - although you should always make sure that your GE physician is aware of the procedure.  It may be that he/she is not knowledgeable of it, since it is quite new and not promoted by the GE community since there are no drugs involved, no intellectual property to protect and thus no particular benefit to big pharma. 

While some of the articles listed in the Appendix describe particular protocols, they are all different in their details, and there is no single protocol that has been generally accepted.  The physicians who are current practitioners of the technique all have their own, and if you are interested, you should contact them directly.

The trials described in the articles all seem to have been conducted at a university or private clinic setting.  However, the physicians who are the leaders in this field are well respected internationally.   At the end of this document is a list of medical journal articles that discuss the treatment.
       

Why does it Work?
You might logically ask why this treatment works at all.  We have been trained from young people that fecal matter can carry a host of diseases, and is to be avoided.  Much sickness in underdeveloped countries comes from that source.  So how could it ever be a good thing to transplant feces from one person to another?  This aspect is one of the reasons why the donor must be tested prior to the procedure to make sure that there are no pathogens in the donor stool.

Grehan writes, “The human gut contains a complex mix of organisms, consisting of a compact mass of living bacterial cells, with almost nine times more living cells (in it) than (in the rest of) the entire body.”
   
Because the human gut has so many different types of bacteria, some of which are good for us, and others are pathogenic, it would be logical to perform a complete analysis to determine the total microbiotic constituents of the gut in a healthy and a sick person and compare the two, looking for a difference.  There are experimenters applying themselves to this analysis, but even with fast DNA analysis, the difficulties are immense because of the bacterial complexity.

Most experimenters believe that sick guts have a deficiency of one or more crucial bacteria - and perhaps the presence of a pathogen.   Thus, they believe that transplanting fecal matter from a healthy patient will help restore the missing ingredient or “swamp” a pathogenic one and inhibit their growth.  And this appears to be the case, because  trials have shown that eventually, the patient’s flora becomes very close in constituents to that of the donor as the patient recovers.

Another supposition as to why fecal transplantation works is that, as Borody writes, “the chronicity of UC could be due to the implantation of (unwanted) spores in the mucosal surface.  Antibiotics may help transiently but are unlikely to be curative because the spores are not eradicated...with current antibiotics.”
                       
Durability
One of the most interesting issues of FMT is its “durability” - that is, how long the positive effect lasts after a treatment.  In the case of C.-diff treatment, as impossible as it might seem, a single treatment is often all that is needed to effect a “cure”, and is fast becoming the accepted treatment for intractable infections of that kind. 

With other bowel conditions, such as UC, ongoing trials show that continued small-volume enemas are required over several months before existing pharmaceutical medications can be tapered off.
               
Summary           
In summary, this is an unusual treatment, not well-known in the GE community.  It is a bit messy (and smelly, no doubt), but is inexpensive, drug-free, minimally-invasive, can be done at home and offers the possibility for the patient of getting off all medications.  In fact, experimenters have shown that a truly sick patient is not at all put off by the prospect of receiving donor feces if there is a good chance of improving their lot.

At the moment (May 2012), this technique has proven itself very effective for C. diff., and somewhat less so for IBS, chronic constipation, chronic diarrhea, pseudomembranous colitis (PMC),  and UC.  I have not seen any experience with Crohns.  It is even being tested for use in Parkinson’s patients.

Physicians
The only physician who I have been able to locate in the Washington, DC area who practices FMT is Dr. Sudhir Dutta at Sinai Hospital in Baltimore. 

I have corresponded with Dr. Lawrence Brandt at Professor of Medicine and Surgery at Albert Einstein College of Medicine in NYC and Dr. Thomas Borody in Sydney, Australia.  Both have written extensively on the subject.