In an ongoing effort to keep readers apprised of the latest, the most interesting, and most unusual stories in medicine, I have come across a medical procedure that fits all three criteria. In addition, this is undoubtedly the grossest medical procedure ever.
Be warned! If you are squeamish, do not read any farther. I say this with a certain amount of authority; I have spent many years immersed to the elbows in people’s internal organs, and covered in bodily fluids, but I was shocked by this. Even the name of the procedure is repulsive, but it is a real procedure that has been successful in treating a very serious problem. What is it?
Fecal transplant … (yes, it’s just what you think it is).
Before we get to the mechanics of the procedure, a digression is in order to explain the disease it is designed to treat. The problem is also unpleasant, but a serious, and growing, danger to our health. The technical name is Clostridium difficile enteritis, but is more commonly known as C. diff infection.
C. diff bacteria are everywhere in our environment, and many of us carry it in our intestines. Normally, it is kept in control by the many other forms of bacteria that reside in our gut. However, when a person takes powerful antibiotics, the majority of bacteria in the gut may be killed off. This allows the C. diff bacteria, which are hardier, to overgrow and produce large amounts of a toxin that inflames the intestines. In effect, this is similar to what happens to many women when they take antibiotics and end up with a yeast infection. The antibiotics kill the normal bacteria of the genital tract, allowing the yeast to take over and cause an infection. Yeast infections, while very unpleasant, are usually not dangerous. C. diff, on the other hand, can be very serious.
Some cases of C. diff infection are mild, causing diarrhea and abdominal cramping. But new strains of C. diff are emerging that produce more powerful toxins and can cause severe, even deadly illness. A severe infection with C. diff can lead to profuse diarrhea, severe abdominal pain, fever and debilitating illness. That’s what happened to Vicki Doriot, profiled in and MSNBC article about the new procedure:
“When those toxins are in your body, you kind of feel like you’re close to death,” said Doriott, 52, an accountant from Eau Claire, Wis., who spent nearly six months battling recurrent bouts of the nasty intestinal bug known as C. diff…
“At its worst, I’d have diarrhea every 15 minutes,” recalled Doriott. “I’d be going for two or three days. I’d have a 103-degree fever. I couldn’t make it two steps from the couch.”
C. diff is caused by powerful antibiotics, but it can be cure by other, equally powerful antibiotics. Unfortunately, a new dimension of C. diff disease has emerged: drug resistant C. diff. Up to 20% of new case of C. diff illness are caused by drug resistant bacteria. There has been some success in treating drug resistant C. diff by using newer antibiotics, but there remain some patients who cannot be cured with antibiotics.
Since C. diff infection is invariably the result of antibiotic treatment that destroys the normal bacteria of the intestines, some scientists and doctors have reasoned that restoring the normal bacteria could allow the body to heal itself. Yet it is not as simple as isolating one or two different kinds of bacteria to use for replacement. It is the complex interaction and interrelationship between many different kinds of bacteria that prevents the overgrowth of C. diff. And where can you find a combination of the right bacteria in just the right proportions? You guessed it … in the gut of someone who does not have a C. diff infection.
That’s how they hit upon the idea of a “fecal transplant.” Not surprisingly, only those patients who are desperately ill are willing to try fecal transplant. That’s what happened to Doriott:
After months of exhaustion and illness, Doriott became desperate enough to consider the fecal transplants she’d heard about through research…
Typically, patients ask a close household member, usually a spouse, to produce a sample of stool, which is tested for disease and infection. In Doriott's case, her husband, Jerry, 50, a civil engineer, was on tap.
On the day of the transplant, donors provide the feces, which is blended and filtered. A tube is fed through the patient’s nose into the stomach and several teaspoons of the sample are injected through it.
“I refused to look at it,” said Doriott. “All I felt was a coolness. It didn’t smell.”
Doriott said she felt better immediately and hasn’t suffered a C. diff relapse since the treatment…
There have been enough patients willing to undergo the procedure that a formal study has been published:
A 2003 case study of 18 patients who received fecal transplants found that two patients who were very ill died shortly after transplant. But of the remaining 16 patients, only one developed C. diff again, according to the study published in the Journal of Clinical Infectious Diseases.
The use of fecal transplant is reminiscent in some ways to the early treatment of other serious illness. Before insulin was identified as the missing component in diabetes, scientists showed that an extract from ground up pancreas was able to cure diabetes in dogs. Eventually, insulin was isolated from the extract, and that became the standard treatment.
Ultimately, doctors and scientists will probably be able to determine the most important intestinal bacteria that need to be replaced in order to treat C. diff infection, and fecal transplant will be replaced by biotherapy with bacteria grown in sterile culture. Until then, though, this primitive form of biotherapy will have to do. It may be gross, but it is a literally life saving therapy, based on sound biologic reasoning, that allows a body to ultimately heal itself.