The Importance of Fecal Transplants
OK, this is about the grossest thing I’ve read all day. The article from Slate summarize an interview with Lawrence Brandt, a gastroenterologist from New York, who is proposing to rejuvenate the intestinal flora of patients suffering from Clostridium difficile infections by giving them microorganisms ideally from the intestines of closely related family members. C. difficile is the causative agent of a form of gastroenteritis which has been increasing in prevalence recently. Development of disease due to C. difficile has been closely associated with antibiotic use, which can eliminate many of the benign microorganisms that are associated with the human digestive tract in the absence of disease. Current estimates suggest 250,000 cases per year in the United States, with several thousand deaths each year. The standard medical remedy is a regimen of more powerful antibiotics. This can begin to bring the tough C. difficile bacterial cells under control, but will further wreck havoc with the remaining intestinal microorganisms, leading to potentially frequent recurrence of the disease. In healthy individuals, the presence of the normal microorganisms in the human intestine serves to keep pathogenic bacteria from becoming prevalent.
So, here’s another solution to the problem. Since the problem of C. difficile infection is exacerbated by the limited numbers of benign bacteria, why not try to replenish the normal bacteria? This is essentially the premise behind probiotics, where microorganism acquired via the diet are intended to colonize the intestinal tract. The patient treated by Dr. Brandt in the Slate article reported spending $350 per week on probiotic treatments, with no resolution of her symptoms. Dr. Brandt then suggested the radical idea of fecal transplant as a “mega-probiotic” treatment to rapidly replenish the missing microorganisms in the gut. I will leave the details of the procedure for the brave of you to look up yourself on the Slate article (hint: it involves a bucket, a blender, a liter of saline, and a tube,) but Dr. Brandt’s patient said that the procedure cured her when standard treatments all failed for two years.
What’s the medical community stance on all of this? There a few widely spaced reports in the medical literature detailing these approaches for therapy, and there is also anecdotal evidence in support of its efficacy. Gastroenterologists interviewed in the article were willing to entertain the notion, but were not enthusiastic about actively promoting this to their patients. Dr. Brandt is currently applying for federal grant funding to carry out double blind studies in a clinical trial with patients. Slate observes that drug companies are unlikely to embrace this novel approach to therapy though:
A single pill of vancomycin … costs about $55, and the average dose is four pills daily over a two-week stretch. A glass of sh#t, on the other hand, costs very little.
So I guess that none of us will have to worry soon about whether we need to get pre-approval from Highmark Blue Shield before we see the doctor for this!
Bonus points for anyone who can figure out why I inserted the graphic above!