Bowel problems? A fecal transplant may help

Clostridium difficile (AKA C. diff) infects about 250,000 Americans each year and has a fatality rate of  almost 10%. It has become a big problem in hospitals where aggressive anti-biotic treatment can kill “good” intestinal bacteria which allows the C. diff bacteria to take over. There are several treatments for C. diff, including in severe cases, colostomy. Many are ineffective and patients can suffer for years from this painful and debilitating condition.

According to this story (from Slate) there is a new treatment for C. diff that is virtually 100% effective – fecal transplant. Wait, WHAT? Fecal transplant??

One day in 2008, Ruth, a Long Island teacher, walked into her doctor’s office with a container of a relative’s feces, lay down, and had her doctor pump the stool inside her. Ruth had been suffering for nearly two years with an intestinal infection called Clostridium difficile, which caused her to suffer from excruciating diarrhea. She had lost 20 pounds. Her hair was falling out. Friends asked if she had cancer.

Then she met Lawrence Brandt, a gastroenterologist at the Montefiore Medical Center in the Bronx who believed he had developed a procedure to cure people of recurrent c. diff infections: fecal transplant. Brandt has been inserting feces into his patients for a decade now and claims to be solving their problems nearly 100 percent of the time. If his method really works—and he’s not the only doctor who believes that it does—then we may have found a viable, if weird, solution to a serious problem. C. diff infects 250,000 Americans each year and killed more than 20,000 from 1999 to 2004. (Researchers estimate that 13 out of every 1,000 patients admitted to a hospital will pick up the bug.) Antibiotics will always be the first response to such infections, but when those fail, a fecal transplant could be the next step. For Ruth, at least, the procedure was a godsend. “I’m cured,” she said. “Period. End of story. Cured.”

For all its promise, it’s unlikely fecal transplants will take off any time soon. Not because patients are grossed out by the procedure—in fact, doctors say that long-standing sufferers from C. diff are eager to have it done—but because there’s so little funding for large-scale clinical trials. Drug or medical-device companies usually foot the bill for such research, but in the case of a natural, patent-free treatment like this, no company stands to turn a major profit. If anything, fecal transplants would end up costing the pharmaceutical companies money: A single pill of vancomycin—one of two antibiotics used to treat C. diff—costs about $55, and the average dose is four pills daily over a two-week stretch. A glass of shit, on the other hand, costs very little. That doesn’t mean we’ll never get the much-needed data: Lawrence Brandt, the gastroenterologist in the Bronx, is applying for a grant with the National Institutes of Health for a small, double-blind, controlled study. He says he’ll need about 40 patients, and he’s hoping to get started right away.

Faster, please…

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