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Fecal Implants or Fecal Microbiota Transplantation by Michael Hinrichs

By at March 15, 2013 | 9:44 am | Print

This topic caught my interest as it ties into many subjects.  Coprophagia, or eating feces, is a common behavior in dogs and in many animals.  In some herbivores, the mother will feed its feces to its young in order to pass on its on bacteria to them, presumably to aid in digestion of raw plants.  Also, I’m in the nursing program here, and washing hands is taught over and over as the best way to prevent disease from being passed from one patient/caregiver to another.  But, I recently learned that there are more bacteria living within the human body than there are human cells- as much as ten times as many!  So it seems that while we worry about infecting each with disease from microbes, exposure to microbes may be needed to boost our immune defenses and beneficial bacteria introduced (or reintroduced) to the gastrointestinal system to reestablish the normal flora there.  This is done in the case of certain harmful bacterial infections in the gut or chronic diarrheal conditions, as we shall explore.

Often, patients who have had gastrointestinal issues like diverticulitis (a disease of the intestines in which small pouches form and often become inflamed or infected) of the colon and have been treated with powerful antibiotics, have their normal bacteria flora wiped out.  This gives an opportunity for a harmful bacterial organism like Clostridium difficile to multiply and dominate the gut flora.  This often produces chronic diarrhea, bloating, and abdominal pain.

Repeated antibiotics treatments are given trying to knock out the C. difficile infection, to no avail.  A new treatment for this and similar conditions like irritable bowel syndrome have been developed.  Fecal implants, or more properly called, fecal microbiota transplantation is a procedure where feces from a donor, often a relative, is implanted far up the intestines via the anus.  This is accomplished through a surgical procedure called colonoscopic infusion or an enema.  The potential donors are screened for proper blood type and lack of abdominal disease.  After the procedure, the patient often recovers in a matter of hours or days in over 90% of the cases seen.  One patient, who had been bed-ridden with chronic diarrhea for weeks, was able to be discharged the next day.  Sometimes, healthy medical staff is used as donors if a volunteer can’t be found quickly.

This treatment is similar to eating probiotic yogurt to restore normal bacteria to aid in digestion, but often much of these probiotic elements are destroyed by stomach acids.  The feces transplant is a more effective way to deliver friendly bacteria into the digestive system.  This procedure had been more commonly used in the first half of the twentieth century on hospital wards but fell out of practice with the introduction of antibiotics.  Now with the rise of antibiotic-resistant bacteria like C. difficile, older procedures like feces enemas may become more common. It is thought that there is some kind of communication or signaling between the normal bacteria of the gut and the mucosal cells of the intestinal lining that restores the balance that was disrupted by the antibiotic therapy.

There is quite a bit of new research into the various species of bacteria and other organisms that find the human body so hospitable.  Medicine seemed to always consider these organisms a threat to be eradicated.  Maybe, they helped us evolve into who we are. And if they are out of balance, many diseases like obesity, diabetes, irritable bowel syndrome, and even rheumatoid arthritis may result.  Wonder medicines like antibiotics have saved many people who would otherwise have died from infections.  But we have found that they are two edged weapons that can lead to other issues.  I see a future where genetically programmed bacteria or antibiotic are introduced into an infected area to combat another specific bacteria or toxin to overcome the infection without the use of a broad spectrum antibiotic.

References: internet links

http://www.sciencedaily.com/releases/2008/06/080603085914.htm

http://www.scientificamerican.com/article.cfm?id=swapping-germs

http://www.mayoclinic.org/medicalprofs/fecal-transplants-ddue1012.html

 

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