A false color micrograph of Clostridium difficile
Advocates say don’t pooh-pooh fecal transplants
At first flush, the topic of fecal transplants is likely to provoke a kind of automatic gag reflex, but the procedure boasts a growing army of advocates. Most recently proponents heard the call to alarm when the Food and Drug Administration proposed tightening restrictions on when and how transplants could be done and by whom.
Fecal transplants are used to treat patients suffering from infections by the bacterium Clostridium difficile, an aptly named bacterium that can cause severe inflammation of the colon, produce life-threatening diarrhea and is extremely problematic to treat. The U.S. Centers for Disease Control and Prevention estimates roughly 14,000 Americans die from “C. diff” each year.
Fecal transplants are a relatively new remedy. In the procedure, the patient’s infected intestines and colon are completely flushed of its microbiome – the vast assemblage of microorganisms, good and bad, that reside specifically in the gut.
Doctors then attempt to repopulate (re-poop-ulate?) the cleansed gut with colonies of healthy microbes from the diluted stool of a health person, often a relative. (Researchers are also working to develop artificial poop derived from a mix of 33 bacterial strains.)
There’s accumulating evidence that, at least in some cases, fecal transplants are extremely effective. A study published earlier this year in the New England Journal of Medicine, for example, reported that 81 percent of patients infected with C. diff recovered completely after a single fecal infusion.
The FDA, however, expressed concern that the procedure was becoming too popular. Or more precisely, that unqualified doctors were promoting it for unproven purposes. Like any medical procedure, there are risks involved in fecal transplants, not the least being that it can result in other bacterial infections.
The FDA’s proposal to require that doctors seek special approval before any transplant provoked immediate opposition from physicians who said doing so would endanger patients who cannot wait for a government OK.
In the end, the FDA acknowledged those concerns and backed off greater regulation. Nonetheless, the agency said it would vigorously enforce current rules and warned that fecal transplants should only be used on patients with C. diff who have not responded to other therapies.