Fecal bacteriotherapy

  Fecal bacteriotherapy, also known as fecal transfusion, fecal transplant, or human probiotic infusion (HPI), is a medical treatment for patients with pseudomembranous colitis (caused by Clostridium difficile), ulcerative colitis and irritable bowel syndrome which involves restoration of colon homeostasis by reintroducing normal bacterial flora from stool obtained from a healthy donor.

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Description of procedure

The procedure itself involves a 5 to 10 day treatment with enemas, made of bacterial flora from feces of a healthy donor (who needs to be tested for a wide array of bacterial and parasitic agents). The enemas are prepared and administered in a hospital environment to ensure all necessary precautions. The probiotic infusion can also be administered through a nasogastral tube, delivering the bacteria directly to the small intestine.^[1] The two methods can be combined to achieve the best result. Regular checkups are required up to a year following the procedure.

Theoretical basis

The hypothesis behind fecal bacteriotherapy rests on the concept of bacterial interference - using harmless bacteria to displace pathogenic organisms. This approach to combating bacterial infections is not new^[2], and has long been used in animals - for example, to prevent salmonellosis in chickens^[3]. In the case of pseudomembranous colitis the pathogen is known (C. difficile), but since no single pathogen causing ulcerative colitis has been found so far, the effectiveness of fecal bacteriotherapy suggests that the cause of ulcerative colitis may be a previous infection by a still unknown pathogen. It is possible that this initial infection resolves itself naturally, but somehow causes an imbalance in the colonic bacterial flora, leading to a cycle of inflammation (explaining the remitting-relapsing nature of the disease) which can be broken by recolonizing the colon with bacteria from a healthy bowel^[4]. This may be considered an extension of probiotic research.

Effectiveness

The procedure has been used to successfully cure C. difficile infections for a number of years, with a success rate of nearly 95% according to some sources^[5][6][7]. The benefits of fecal bacteriotherapy include reducing the risk of antibiotic-associated resistance, cost savings when compared to repeated courses of antibiotic therapy, and high success rate. It is still considered a "last resort" therapy due to the inherent risks involved, and lack of Medicare coverage for donor stool screening and instillation procedure.[1]

While its effects on ulcerative colitis have not yet been adequately researched, small case series suggest it has positive effects. A recent article by Borody et al which details 6 cases of severe chronic ulcerative colitis treated using Fecal bacteriotherapy suggests that the procedure may be extremely successful in these cases as well. Complete reversal of symptoms was achieved in all patients by 4 months post-HPI, by which time all other UC medications had been ceased. At 1 to 13 years post-HPI and without any UC medication, there was no clinical, colonoscopic, or histologic evidence of UC in any patient^[8]. The Sydney group also reports a case of presumed sclerosing cholangitis, a disease frequently associated with IBD, which recovered fully after the treatment.

History

It has been developed in recent years by Dr. Thomas J. Borody and his team in Sydney, Australia, primarily as an alternative treatment for pseudomembranous colitis. This disease is caused by C. difficile infection, and is typically treated with antibiotics.

See also

• Pseudomembranous colitis
• Ulcerative colitis
• Irritable bowel syndrome
• Inflammatory bowel disease
• Helminthic therapy

References