The biggest problem with a medical procedure known as fecal transplant is not what many people might imagine — the yuck factor. People who could benefit from the treatment tend to get over that quickly when they hear it might cure them of C. difficile, a nasty bacterial infection that can cause months of recurring diarrhea, doctors say.
Instead, inconvenience, costs and other logistical factors are getting in the way of more widespread use, say researchers who today report some progress on overcoming those barriers.
Specifically, in a small pilot study, they found that frozen stool samples from donors unrelated to patients seemed to work as well as fresh samples from family members worked in previous studies. They also found that the frozen stuff worked whether people got it through a colonoscopy or through a much simpler, cheaper method — a feeding tube threaded from the nose to the stomach.
Doctors elsewhere have been trying similar strategies and reporting good results. The new publication could help spread such techniques, says study co-author Elizabeth Hohmann, an infectious disease specialist at Massachusetts General Hospital in Boston.
C. difficile infection is often picked up in hospitals and typically develops in guts thrown out of whack by antibiotics. It's then treated with more antibiotics, which often fail. Fecal transplants can often restore a healthy balance of gut microbes.
In the study, published in Clinical Infectious Diseases, researchers got a 90% cure rate in 20 patients treated with stool from unrelated donors that was frozen for up to 156 days, then thawed for use. All had previously failed multiple antibiotic treatments..
Fourteen were cured after one round; five tried a second round and four of them were cured. Researchers later found that a young man who turned down a second round was trying a do-it-yourself version at home — giving himself enemas with a roommate's stool.
The man did OK, "but it's not something I would recommend," Hohmann says. Donors in the study were screened for infectious diseases and other conditions and that's a prudent safety step, she says.
In the future, donors may be further screened to match their gut microbes with the needs of individual patients, says James Versalovic, chief of pathology and director of the Microbiome Center at Texas Children's Hospital, Houston. That will become more crucial, he says, as fecal transplants are tried for a wider variety of conditions in which the microbes might play a role — everything from obesity to inflammatory bowel disease.
Versalovic says his hospital uses frozen feces and that having banked materials on hand does simplify and speed up treatments. The children he treats get their transplants via colonoscopy. Versalovic says he's skeptical many would accept the nose-tube method.
In the Boston study, all five patients who got second treatments chose the nose tube over colonoscopy — a method that requires sedation, can cost more than $2,000 and often is not covered by insurers, Hohmann says.
Having a nasal tube placed can cause brief discomfort and there's a risk of vomiting, but "after people have been sick with this for a year, they will accept it," Hohmann says.
The Boston researchers are now trying a more concentrated version of the frozen feces in a capsule — a "poop pill" much like the one recently reported by Thomas Louie, a researcher at the University of Calgary.
Louie says he's now making his pills with frozen samples, too. "It seems to work just fine," he says and is more convenient than seeking out a just-in-time donor for every patient.
The potential market for easier fecal transplants is big: C. difficile alone leads to 250,000 hospitalizations and 14,000 deaths in the United States each year, according the Centers for Disease Control and Prevention.