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Fecal Transplants in Clostridium difficile Infections and IBD

Updated on August 30, 2017
AliciaC profile image

Linda Crampton is a teacher with a first class honors degree in biology. She writes about human biology and the scientific basis of disease.

The stomach leads to the small intestine, which in turn leads to the large intestine. Most of our gut bacteria live in the large intestine.
The stomach leads to the small intestine, which in turn leads to the large intestine. Most of our gut bacteria live in the large intestine. | Source

The Importance of Bacteria in the Intestine

The human body contains at least ten times more bacterial cells than human ones. Many of the bacteria live in our large intestine and are very helpful. They are so important in our lives that without their presence we may experience disease. Doctors have discovered that a sample of feces containing the bacteria from a healthy person can be used to treat some intestinal diseases. The feces (or stool) is delivered to the patient as a fecal transplant.

As unpleasant as fecal transplants may sound, they have been a wonderful boon for some people. The transplants have been most helpful for people suffering from a persistent Clostridium difficile infection and have a high success rate in treating this illness. They have also helped some people with inflammatory bowel disease, or IBD. It's possible that fecal transplants will become even more useful as researchers learn more about the composition and function of our microbe community.

The tubular structure in which digestion occurs is called the gastrointestinal tract, GI tract, digestive tract, or gut. The tube runs from the mouth at the start to the anus at the end. The bacteria in the small and large intestine are known as gut bacteria or intestinal bacteria.

This is a colourized photo of E. coli cells. The normal strains of E. coli in our gut are different from the ones that make us sick.
This is a colourized photo of E. coli cells. The normal strains of E. coli in our gut are different from the ones that make us sick. | Source

The Intestinal Microbiome

The bacteria that live in our large intestine are accompanied by a smaller number of yeasts and other microscopic organisms. Many of the microbes live in the colon, the longest part of the large intestine. Some live in the small intestine, however, especially in the ileum, which is the last section of the small intestine.

It's thought that between 500 and 1000 different kinds of bacteria and trillions of individual ones normally live in the large intestine. Most of these microorganisms are helpful, but some are harmful. A healthy gut has far more beneficial microbes than harmful ones.

The community of microbes on or in the human body is called a microbiome. It may seem strange that we contain more bacterial cells than our own cells. This is possible because bacteria have smaller cells than humans and because the bacteria often colonize cavities in our bodies.

Benefits of Intestinal Bacteria

The relationship between us and the helpful microbes in our gut is mutually beneficial. Colon bacteria feed on nutrients that enter the large intestine from the small intestine. The intestine also provides a warm and moist habitat for the bacteria. The bacteria help us by producing nutrients that we absorb, such as vitamin K and biotin.

Another benefit of gut bacteria is that some ferment the soluble fibre that we eat into short-chain fatty acids. These acids are thought to have many helpful effects, including enhancing the activity of the immune system, improving the structure and function of the intestinal lining, lowering the blood cholesterol level, and helping to regulate the blood glucose level.

Good bacteria also help to prevent the growth of pathogens (disease-causing microbes) in the large intestine. In addition, they break down material that we are unable to digest. They may also reduce inflammation and have other health benefits.

The Importance of the Human Microbiome

Our microbiome is so important that the National Institutes of Health (NIH) has established a special project to study it. The goal of the Integrative Human Microbiome Project is to catalogue the microorganisms found on and in the body and to discover their role in health and disease.

Fecal Microbial Transplantation from John Hopkins Medicine

Intestinal Problems Treated by Fecal Transplantation

At the moment, most fecal transplants are performed to treat gut disorders caused or suspected to be caused by gut dysbiosis (an abnormal community of bacteria in the gut). The process of fecal transplantaction is sometimes known as fecal bacteriotherapy, fecal microbial transplantation, or FMT.

Some patients with a Clostridium difficile infection, Crohn’s disease, or ulcerative colitis have responded well to fecal transplantation. Clostridium difficile is an infectious bacterium and is one of the superbugs. Crohn’s disease and ulcerative colitis are forms of inflammatory bowel disease, or IBD. (Bowel is another name for intestine.) Researchers have recently discovered evidence suggesting that people with inflammatory bowel disease have an abnormal community of gut bacteria and that this community is determined by a person's genetic makeup.

Fecal transplants have about a 90% success rate in people with a persistent and serious Clostridium difficile infection. In addition, the improvement in the patient's condition may occur as soon as one to three days after treatment. Fecal transplants have about a 45% success rate for people with inflammatory bowel disease. The success rate is higher in some subgroups with IBD and lower in others. The lower success rate for IBD than for a Clostridium difficile infection may reflect the fact that IBD seems to involve more than just a gut bacteria problem.

Clostridium difficile cells
Clostridium difficile cells | Source

Clostrifium difficile or C. Diff Infections

Clostridium difficile is a bacterium that infects the large intestine, causing colitis (inflammation of the colon), severe diarrhea, nausea, vomiting, abdominal pain, dehydration, and a fever. Infection by Clostridium difficile, also known as C. difficile or C. diff, may occasionally be fatal.

C. diff is classified as a superbug. Infections tend to develop in hospitals and other medical facilities, although they appear in the general community as well. Like other superbugs, the bacterium is resistant to many antibiotics and is difficult to kill. In fact, the infection often appears in patients who have been taking antibiotics for a different infection. The antibiotics kill other bad bacteria and good bacteria as well, but don't affect C. diff. Without good bacteria to keep C. diff under control, the Clostridium difficile population increases and causes unpleasant effects. In some places, a fecal transplant may be offered to people when antibiotics don't get rid of C. diff.

What Is Crohn's Disease?

Crohn's Disease Facts

Crohn's disease is a disorder involving inflammation of the gastrointestinal tract. Any section of the GI tract may be inflamed, from the mouth to the anus. The lower part of the small intestine and the first part of the large intestine are the most common sites affected, however. Patches of inflamed tissue appear on the intestinal lining and may be deep.

The cause of Crohn's disease isn't known. It is known that the patient's immune system behaves abnormally, which results in damage to the GI tract. The immune system may be responding to the presence of certain bacteria in the gut and may stay active even when these bacteria are destroyed. There seems to be a genetic tendency to develop the disease when the right environmental trigger appears.

Patients with Crohn’s disease may have mild symptoms or severe ones that make life very difficult and unpleasant. Gastrointestinal tract problems often include bloody diarrhea and abdominal pain. Symptoms may extend beyond the GI tract. The patient may suffer from loss of appetite, weight loss, fatigue, joint pain, fever, nausea, vomiting, skin problems, and eye inflammation.

People with Crohn's disease generally experience flare-ups, or periods when their symptoms are severe, alternating with periods of remission when their symptoms are weaker or absent.

What Is Ulcerative Colitis?

Ulcerative Colitis Facts

Ulcerative colitis produces similar symptoms to those caused by Crohn’s disease, but the intestinal effects are slightly different. The inflamed tissue in the intestine generally appears only in the colon and the rectum (the chamber at the the end of the large intestine that stores the feces before it's eliminated). In addition, only the surface layer of the intestinal lining is affected in ulcerative colitis, while in people with Crohn's disease the damage goes deeper into the lining.

As in Crohn's disease, the immune system is behaving abnormally in a person with ulcerative colitis. Also as in Crohn's disease, the cause of the disorder isn't known for certain. It may be due to either the presence of harmful bacteria or an inappropriate immune response to healthy ones.

People with ulcerative colitis experience flare-ups and remissions. They are more like to experience an absence of symptoms during remissions than people with Crohn's disease.

Fecal Microbiota Transplantation and Stool Preparation

Fecal Transplantation

Fecal transplantation is an attempt to correct a health problem by improving the composition of the gut flora. The goal is to insert beneficial microoganisms into the large intestine. The transplanted microbes will hopefully reproduce, fighting or crowding out dangerous bacteria.

Fecal transplantation is not a new technique. It's been performed since the 1950s. The process has only recently begun to be seriously investigated by researchers, however.

Dr. Thomas Borody, an Australian gastroenterologist, is a leading practitioner of fecal transplants. He is not only treating gut disorders with fecal transplants but is also investigating whether other disorders such as multiple sclerosis, chronic fatigue syndrome, and Parkinson's disease can be improved by fecal transplants. Other doctors are trying to find out if transplantation of beneficial bacteria from the stool of lean people into overweight people can treat obesity.

The transplanted stool is inserted into the colon or occasionally through a tube inserted in the nose or mouth. The recipient doesn't smell or taste the stool that is administered by the second method. Some companies are exploring the use of a capsule containing the bacteria that could be swallowed. A research team has discovered that in the patients that they studied, the donated bacteria were still present in the intestine two years after a transplant.

A Fecal Transplant for a C. difficile Infection

Safety Concerns

Fecal transplants are simple to perform and often have rapid benefits. However, the transplantation must be done by a doctor or under a doctor’s guidance. Safety is extremely important. The sample of feces must be prepared properly. In addition, donors and their feces need to be screened for known parasites so that the recipient doesn't develop a serious or even deadly infection as a result of the transplant.

It's very important that donated feces is checked for the presence of dangerous bacteria and other parasites before any type of fecal transplant is performed.

The Acceptibility of Fecal Transplantation

At the moment, fecal transplantation is usually considered to be a “last resort” treatment for patients suffering from debilitating or very dangerous intestinal problems who have tried all other treatments without success. This is because there hasn’t been much scientific research concerning fecal transplantation (although this situation is currently changing) and also because of the difficulty in ensuring that the donated feces is prepared properly and is free of pathogens.

As the effectiveness of the treatment is being demonstrated—especially in the case of serious C. diff infections—their use is spreading. Where I live, the procedure is becoming more acceptable and more common. Fecal transplants still have limited availability at the moment, however.

A fecal transplant may sound repulsive to a healthy person. For someone who is experiencing debilitating intestinal symptoms, however, the procedure often sounds like it could be a godsend. Hopefully researchers will discover ways to make fecal transplants effective for even more people and diseases.

References

  • "C. difficile infections could be treated with fecal transplants beyond clinical trials." Canadian Broadcasting Corporation. http://www.cbc.ca/news/health/c-difficile-infections-could-be-treated-with-fecal-transplants-beyond-clinical-trials-1.3016158 (accessed August 28, 2017).
  • Hansen, Jeff. "Donor microbes persist for up to two years after a fecal transplant to treat recurrent C. difficile infection." University of Alabama at Birmingham. http://www.uab.edu/news/innovation/item/8408 (accessed August 28, 2017).
  • Ibarra, Rose. "Study Suggests Fecal Transplant Could Be Effective Treatment for Crohn's Disease." Seattle Children's Hospital. http://pulse.seattlechildrens.org/study-suggests-fecal-transplant-could-be-effective-treatment-for-crohns-disease/ (accessed August 30, 2017).
  • Weill Cornell Medicine. "Fecal microbiota transplant is safe and effective for patients with ulcerative colitis." ScienceDaily. www.sciencedaily.com/releases/2017/04/170427091746.htm (accessed August 28, 2017).
  • Grover, Natalie. "Drugmakers tackle 'ick' factor with fecal transplant therapies." Reuters. https://www.reuters.com/article/us-cdiff-drugs-idUSKCN1B81X3 (accessed August 30, 2017).

© 2011 Linda Crampton

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    • AliciaC profile image
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      Linda Crampton 21 months ago from British Columbia, Canada

      Thank you very much for the interesting comment and for sharing your experience and opinion, Aelbarsha. I appreciate your visit.

    • Aelbarsha profile image

      Abdelhakim Elbarsha 21 months ago from Benghazi/Libya

      Thanks for great hub.

      The issue of fecal transplantation is hot. The evidence is growing regarding the effectiveness of fecal transplantation in curing many gut disorders, and probably systemic diseases like metabolic syndrome.

      The future may bring more, and other diseases not related to the digestive tract may be targeted by restoring a normal colonic bacterial population.

      I personally expect that many diseases labelled as "idiopathic" are caused by abnormally increased exposure to external toxins or antigens delivered to our system from an altered colonic medium.

    • AliciaC profile image
      Author

      Linda Crampton 5 years ago from British Columbia, Canada

      Thanks for sharing a very interesting story, Toppin Martin. I'm glad that the fecal transplant worked so successfully for you!

    • profile image

      Toppin Martin 5 years ago

      Had eleven months of C.Diff. Had colonoscopy during which the fecal matter from my best friend was deposited along the length of colon. I am now C.Diff free. The only thing that allowed me to be functional during those eleven months was a steady diet of Vancomycin at the cost of $196 per day day dose. It's a simple procedure with cure rates over 90%. Don't live with this. Get the transplant!

    • AliciaC profile image
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      Linda Crampton 6 years ago from British Columbia, Canada

      Thank you for the comment and the vote, kashmir56!

    • kashmir56 profile image

      Thomas Silvia 6 years ago from Massachusetts

      Hi AliciaC, thanks for all this great information, i have not heard of this before so thanks for making me aware of it .

      Useful and vote up !!!

    • AliciaC profile image
      Author

      Linda Crampton 6 years ago from British Columbia, Canada

      H, prasetio30. Thank you for visiting my hub and for the rating!

    • prasetio30 profile image

      prasetio30 6 years ago from malang-indonesia

      I had never knew about this. I learn much from you. Thanks for writing this. Rated up! Have a nice weekend..

      Prasetio,

    • AliciaC profile image
      Author

      Linda Crampton 6 years ago from British Columbia, Canada

      I'm glad that your friend found help for her colitis, Fossillady. It can be a horrible disorder. The more treatments discovered the better!

    • Fossillady profile image

      Kathi 6 years ago from Saugatuck Michigan

      I have a friend who suffers from colitis and it really messed up her daily life. She had surgery to remove a blockage and is doing great now! It's always good to know they are making more advances.

    • AliciaC profile image
      Author

      Linda Crampton 6 years ago from British Columbia, Canada

      Hi, Chatkath. Thanks for the comment. You must have some interesting discussions with your sister!

    • Chatkath profile image

      Kathy 6 years ago from California

      Wow, this is really interesting stuff, I must say. My sister is a nurse/director at an endoscopy center so I hear a bit too much sometimes about the procedures but this is all stuff I did not know! Great and informative Hub!!!

    • AliciaC profile image
      Author

      Linda Crampton 6 years ago from British Columbia, Canada

      Hi, A. A. Zavala. Yes, fecal transplantation is probably very unappealing for most people, and researchers don’t yet know if it will work for everyone who has Crohn’s disease or other severe intestinal problems. However, the people that I’ve read about who received a fecal transplant were having a miserable life, in pain and unable to move far from a bathroom. In this situation I guess they thought it was worth receiving the transplant.

      Thank you very much, Simone!! At the moment a fecal transplant sounds very disagreeable to me too, but if I had a health problem that was serious enough, and if there there was evidence that a fecal transplant might help, I would consider it.

    • Simone Smith profile image

      Simone Haruko Smith 6 years ago from San Francisco

      Whoah. Wow. Wow! You've offered an excellent discussion of the subject- and it sure is an interesting one! Voted up and useful... I just hope I never need a fecal transplant =_=

    • A.A. Zavala profile image

      Augustine A Zavala 6 years ago from Texas

      Its a bizarre way of treating Crohn's, and patients may not like the idea. I'm just glad we're looking at all options in treating disease.

    • AliciaC profile image
      Author

      Linda Crampton 6 years ago from British Columbia, Canada

      Yes, it is fascinating! I'm very interested in the research concerning the effects of fecal transplantation on other health problems in addition to intestinal disorders.

    • A.A. Zavala profile image

      Augustine A Zavala 6 years ago from Texas

      I read about the fecal transplantation technique, and heard about it on NPR. Fascinating!