Fecal Transplants Have the Ick Factor, But Research Suggests They Work

Getting a “fecal transplant” sounds like a pretty icky proposition.

But according to data presented at a meeting of the American College of Gastroenterology, the procedure seems to work very well to treat recurrent bouts of Clostridium difficile infection.

To understand the appeal of a fecal transplant, you’ve got to understand the problem it’s addressing. As the WSJ’s Informed Patient column has reported, C. diff infections can occur as an unintended consequence of taking antibiotics; the gut’s bacterial balance gets thrown out of whack, and C. diff grows out of control. Treatment with antibiotics or probiotics doesn’t always fix the problem.

It’s a very simple idea — re-introduce a healthy menagerie of bacteria into the gut — but the mechanics can produce squeamishness. Lawrence Brandt, emeritus chief of the division of gastroenterology at Montefiore Medical Center/Albert Einstein College of Medicine, has been colonoscopically infusing filtered stool into the colons of patients since 1999. He takes a freshly passed stool specimen from a donor (usually a spouse/partner or relative), grinds it up, and filters out solid material through gauze pads.

Once it’s suspended in a sterile saline solution, the solution is infused into the colon, where the healthy bacteria can take root and flourish, restoring the body’s natural balance.

Brandt, also a professor of medicine and surgery at AECOM, is an author of a study presented at the meeting covering 77 patients — most of them elderly and debilitated — who underwent a colonoscopic fecal transplant in five states. It found a 91 percent success rate. No patient developed a subsequent recurrent infection without a course of antibiotics during a follow-up that averaged 17 months.

Brandt says that success rate is “far better” than can be achieved with antibiotics, and of 350 or so fecal transplants reported worldwide, there haven’t been complications. He says it’s increasing in an “exponential fashion,” and that the ick factor is what prevents people from doing it more often.

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