June 22, 2018
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Fecal transplants give relief to those ‘literally living in the bathroom’

By Rob Stein, The Washington Post

For more than a year, Linda Devens was tormented by chills, fevers and, worst of all, unrelenting bouts of diarrhea that required repeated hospitalizations.

“I was literally living in the bathroom,” said Devens, 61, of Andover, Minn. “I wouldn’t wish it on anyone. It was really awful.”

Devens was hit by an increasingly common bacterial infection that is getting harder to beat back with antibiotics. Some victims of Clostridium difficile eventually need part of their colons removed. Some die.

In Devens’s case, she finally agreed to what initially sounded like a crazy idea: getting her digestive system microbes replaced by someone else’s.

A small coterie of doctors in the United States, Europe and Australia have begun doing this for conditions suspected of being caused by disruptions in a healthy “microbiome,” the collection of microorganisms that populate everyone’s body.

The usually last-ditch procedure involves patients flushing out their digestive systems as if they were going to have a colonoscopy. Then, doctors inject microbe-laden feces from a healthy donor — often a spouse or relative — who has been screened for HIV, hepatitis and other disease-causing germs.

The procedure, known as a fecal transplant, has been performed most often and produced the most promising results in patients with “C. diff,” which often strikes people who have taken antibiotics, disrupting the normal protective colonies of organisms in their digestive tracts.

Some doctors report helping between 80 percent and 95 percent of recipients, frequently providing nearly instantaneous relief to those who had almost given up hope.

“In my mind, there is no doubt this is a very effective way of treating this,” said Alexander Khoruts of the University of Minnesota, one of a group of doctors publishing guidelines for the procedure in the December issue of the American Gastroenterological Association’s journal.

While Khoruts currently limits the procedure to C. diff patients, some doctors have begun trying the transplants for other conditions, including Crohn’s disease, ulcerative colitis, irritable bowel syndrome and even obesity.

“I think we are just at the very beginning of understanding the contribution it may make,” said Thomas Brandt of the Albert Einstein College of Medicine in New York, who plans to report the results of transplants on 75 patients to the American College of Gastroenterology meeting in Washington Oct. 28-Nov. 2.

Many experts, however, caution that much more research is needed beyond the largely anecdotal reports so far.

“We haven’t actually proved the fecal transplant is what is making them get better. The proof would have to come from a rigorously controlled randomized trial, which hasn’t been done,” said Robert Karp of the National Institute of Diabetes and Digestive and Kidney Diseases.

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