Ask the Doctors by Eve Glazier, M.D. and Elizabeth Ko, M.D

Study Offers Strong Argument for Benefits of Fecal Transplants

Dear Doctor: I just read that some parts of the medical community may finally be taking the idea of fecal transplants seriously. What are the latest advances? And what's taking so long?

Dear Reader: We think you may be referring to a study about fecal transplants that made quite a few headlines when the results were published in the New England Journal of Medicine in June. Researchers from Norway assessed the efficacy of various treatments on patients with a dangerous and potentially deadly intestinal infection caused by a type of bacteria called Clostridium difficile, also referred to as C. diff. The bacterium causes symptoms that include frequent diarrhea, high fever, nausea and dehydration that can adversely affect heart rate, blood pressure, kidney function and overall health. In the most severe cases, C. diff causes a type of inflammation of the colon that can lead to death.

In the study, 20 patients with C. diff infections were randomly assigned to either undergo standard treatment with antibiotics or to receive a fecal transplant. For those unfamiliar with the concept, that's the process by which specially prepared stool from a healthy individual is transferred into the colon of the sick person. The idea is that the "good" bacteria from the healthy individual will populate the colon of the patient and vanquish the C. diff bacteria. People who donate stool for a fecal transplant undergo extensive testing be sure no pathogens, such as bacteria, fungi, viruses or parasites, get transferred to the recipient.

Of the nine C. diff. patients in the study who received the fecal transplant, five were cured immediately. Five of the 11 patients who received antibiotics were also cured. In this particular study, fecal transplants were shown to be as effective as antibiotics for the treatment of C. diff. In a time of increasing antibiotic resistance, this is an important development. However, the study, with just 20 patients, is too small to use to draw definitive conclusions. The researchers have announced plans to repeat their work with 200 patients in the near future.

As to why progress in the arena of fecal transplants appears to be slow, we think it's a combination of things. Any new approaches in medicine have to undergo comprehensive testing, studies and clinical trials to be sure that they are safe, and to fine-tune the specifics of treatments, dosage and procedures. Compared to how quickly information gets shared these days, the bench-to-bedside process may appear to move at a glacial pace. It's also true that new ideas can face resistance in the medical community. We're thinking of how, in the early 1980s, the idea that peptic ulcers and gastric cancers were caused by certain bacteria was thought to be ludicrous. Two decades later, though, the Australian doctor who came up with the theory, which was eventually proven to be correct, won the Nobel Prize.

At this time, although fecal transplants are permitted by the FDA, they are to be used only when treatment with antibiotics has failed. This new study, despite its small size, may offer a persuasive argument for more extensive research with an eye toward revisiting treatment priorities.

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