Fecal transplants


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Yeah, you read it right and it's a serious subject. They can be used to treat a particularly nasty bowel infection caused by a bug named Clostridium difficile (abbr: C. difficile or C. diff), but getting the treatment approved for widespread use has met bureaucratic and regulatory hurdles....

Link....

Fecal Transplants: They Work, the Regulations Don?t

Lara Thompson was 26 when her life fell apart.

She was living in Rhode Island and working in HIV prevention research when she unexpectedly developed nausea and diarrhea. It was early 2008, a few weeks after New Year?s, and she thought she might have picked up a stomach virus at a holiday gathering, or stressed her system with overindulgence. She expected the symptoms would pass after a few days. They didn?t.

?In three weeks, I dropped 15-20 pounds,? she says now. ?I couldn?t keep anything in; I would have to run to the bathroom at a moment?s notice. I was so lethargic I had to stay home from work.?

When she consulted her doctor, she found out what was bothering her was more complex than a virus. Somehow, her intestinal lining had become infected with Clostridium difficile, or C. diff, a tough and persistent bacterium that has been rising in incidence and gaining antibiotic resistance, becoming increasingly difficult to treat.

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For months, physicians kept trying different drug regimens, while Thompson?s hair fell out and her muscles wasted. By summer, she was down 40 pounds and close to desperate. Scouring the internet for alternatives, she found a description of a treatment that didn?t use drugs. It was a fecal transplant, which is just what it sounds like: inserting strained, diluted feces harvested from someone with a healthy gut into the sick person?s large intestine, in hopes of replacing the devastated colony of bacteria living there with a fresh, robust one.

?It made sense to me,? Thompson says now. ?And I had no other options. I was getting sicker, basically living in the bathroom, crying, emotional all the time.?

She gathered everything she could print out, and found a doctor who was friendly to the procedure: Colleen Kelly, a gastroenterologist based in Providence. In late October 2008, Kelly performed the transplant as an outpatient procedure, after Thompson had done the clean-out preparations that someone does to get ready for a colonoscopy. Her boyfriend was her donor.

In two hours, she started feeling better. In three years, her C. diff has never recurred.

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But, of course, there?s a problem:

? Fecal transplants remain a niche therapy, practiced only by gastroenterologists who work for broad-minded institutions and who have overcome the ick factor. To become widely accepted, recommended by professional societies and reimbursed by insurers, the transplants will need to be rigorously studied in a randomized clinical trial, in which people taking a treatment are assessed alongside people who are not.

Kelly and several others have drafted a trial design to submit to the National Institutes of Health for grant funding. Yet an unexpected obstacle stands in their way: before the NIH approves any trial, the substance being studied must be granted ?investigational? status by the Food and Drug Administration. The main categories under which the FDA considers things to be investigated are drugs, devices, and biological products such as vaccines and tissues. Feces simply do not fit into any of those categories.

So, to be clear, what we have is a treatment that is minimally invasive, reliable, cheap, and with a long clinical history: The earliest documented use in humans goes back to 1958, and it has a longer and still current use in veterinary medicine, especially in racehorses. Also, it works, in more than 9 out of 10 patients. Kelly told me: ?There is no drug, for anything? with a cure rate routinely that high.

And yet, because of this regulatory conundrum, the only physicians practicing it are ones whose institutions are tolerant of their performing an unofficially experimental procedure, and who are strong-stomached enough to get past our evolutionarily hard-wired distaste for dung. So far, only about a dozen U.S. physicians have admitted ? via publishing their case series in medical journals ? to performing fecal transplants, though the procedure?s much more widely accepted in Australia and Europe.

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that is (and I can't believe I'm going to say it about this subject) fascinating

As someone who had a severe case of food poisoning for two weeks I couldn't even imagine what it must be like to have this for longer and then be denied access to such a simple cure due to some stupid regulations

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this is no laughing matter, indeed. but why do we need to put entire chunks of feces inside a person? why not just harvest the good bacteria and put them in the colon?

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this is no laughing matter, indeed. but why do we need to put entire chunks of feces inside a person? why not just harvest the good bacteria and put them in the colon?

Probably a matter of cost, or that the bacterias don't live long outside the fecal matter
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Having been a recipient of this treatment, I can vouch for it, after Rupturing my appendix, I became septic, Gangrene and peritonitis, I was put on a heavy heavy rotation of antibiotics to tear down the infection that was running rampant through my body, this destroyed the good bacteria in my colon and I received a fecal implant (from my brother). It saved my life.

I'm all for it, when you're at deaths door, the ick factor really doesn't matter, if they had said "A horse needs to crap on your face to save your life" I'd have dragged my sick but out to the barn! lol

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I think the reason it is stool and not something cultured in a lab and put into a pill is because no one really knows all the bacteria that live in your gut/colon and gathering a proper sampling of such bacteria is probably impossible.

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Having been a recipient of this treatment, I can vouch for it, after Rupturing my appendix, I became septic, Gangrene and peritonitis, I was put on a heavy heavy rotation of antibiotics to tear down the infection that was running rampant through my body, this destroyed the good bacteria in my colon and I received a fecal implant (from my brother). It saved my life.

I'm all for it, when you're at deaths door, the ick factor really doesn't matter, if they had said "A horse needs to crap on your face to save your life" I'd have dragged my sick but out to the barn! lol

So how was it actually? Did it smell bad? Taste bad? Was it done through IV or another method?

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I wonder if there's a certain type of probiotic that could help with this too... I know I take those regularly to keep the "gut flora", as they say, healthy.

Makes sense to me. We've become so oversensitive to "germs" and so quick to turn to antibiotics for everything that we forget there are loads of good bacteria with which we have a necessary symbiotic relationship.

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Couldn't really tell you, it was primarily a liquid, I was tubed down my throat, it was dumped in. No taste or smell, no additional nausea to speak of (I was feeling sick all the time anyway), it took on the first shot, the volume was only a few cc's I believed. If it hadn't taken, they were talking about a "Live insertion" where in a nutshell, they would sedate me, Open up the rear gates and insert a volume of the pure component. but the liquid worked and I steadily got better.

In total I spent 34 days in the hospital, I was released 4 days after the procedure.

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guess Aerah is right, they're doing this because it's not certain exactly which bacteria are beneficial, so might as well go full tilt.

and thanks for sharing your story devil, surprised out of the neowin community we already have someone who's experienced this. like you said, we're talking about saving your life here, but still...i'd have asked to be sedated. did it look anything like the "pure component" while coming down that tube?

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