Patients Don’t Pooh-Pooh Fecal Transplants

Let’s start this blog with the disclaimer that what you’re about to read has a high “yuck” factor…unless it seems you’re a patient or a parent of a patient with ulcerative colitis.

A new study just published in the journal Inflammatory Bowel Disease examined the social and ethical issues associated “fecal microbiota transplantation” (FMT).

Yes, FMT is just what you’re thinking it is!  Also known as fecal bacteriotherapy, it is a provocative treatment performed in an attempt to calm a troubled bowel by reintroducing the vast diversity of collaborative bowel inhabitants after the usual mix has been disturbed. More than 1,000 different strains of bacteria co-exist peacefully in the typical healthy bowel. But when the delicate balance is altered, by antibiotics or other causes, a few strains can become dominant, leading to severe diarrhea, inflammation and tissue damage.

Although transplants of fecal matter have been used sporadically to treat gastrointestinal disease for more than 50 years, more recently, the approach has produced lasting remissions for a small number of patients with ulcerative colitis.

The first fecal transplants date back to 1958, when they were used to treat life-threatening bowel infections. They did this by collecting fecal matter from a healthy donor and injecting it into the patient’s colon.

Then in 2003, an Australian team published a report on successful treatment of six patients with longstanding ulcerative colitis with this approach.

And although you may be feeling a little squeamish by now, it seems that patients with severe inflammatory bowel disease develop a high tolerance for therapies that others might consider unorthodox. According to study author David Rubin, MD, Associate Professor of Medicine at the University of Chicago, “Once patients get past the yuck factor they find the concept appealing.”

Like an organ transplant, fecal microbiota transplantation begins with finding a donor, often a family member. The treatment team collects a fresh stool sample of at least 200 – 300 grams (7-10 ounces). The sample is mixed with salt water in a blender and filtered to remove particulate matter. It can be administered to the recipient through a colonoscope, as an enema, or, when the inflamed region is higher in the colon, through a nasogastric tube.

The researchers organized six focus groups with patients or parents of children with ulcerative colitis to explore the attitudes and concerns raised by this approach.

They found that:

• 21:22 patients or parents of patients were interested in trying FMT for themselves or their child
• Most wished it were already available
• They viewed the treatment as more ‘natural’ than using drugs to control the disease, and easier and safer than currently available therapies
• Many compared it to probiotics, a popular alternative therapy among patients with colitis.

The major concerns were focused on how donors would be selected and screened. Patients wanted healthy donors, usually family members, and asked that even their diet and medications be considered. A donor who had eaten peanuts recently, for example could be hazardous for a recipient with peanut allergies.

The “yuck” factor came up in the focus group discussions of bacterial delivery. Patients and parent were comfortable with the idea of a “spray” colonoscopy or delivery via enemas, but were disturbed by the idea of using a nasogastric tube for the transfer of fecal bacteria.

“What our study ultimately tells us is that patients are not only tolerant of this therapy but are eager for it to become available,” Rubin said. “A few have already tried this strategy at home, using ‘protocols’ they found on the internet and tools available at any drug store.”

The team plans to begin offering FMT this fall.

Would you sign up for a poop transplant or consider being a donor?