Fecal bacteriotherapy
Encyclopedia
Pseudomembranous colitis
Pseudomembranous colitis, a cause of antibiotic-associated diarrhea , is an infection of the colon. It is often, but not always, caused by the bacterium Clostridium difficile. Because of this, the informal name C. difficile colitis is also commonly used. The illness is characterized by...
(caused by Clostridium difficile
Clostridium difficile
Clostridium difficile , also known as "CDF/cdf", or "C...
), or ulcerative colitis
Ulcerative colitis
Ulcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the colon , that includes characteristic ulcers, or open sores. The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset...
that involves restoration of colon homeostasis
Homeostasis
Homeostasis is the property of a system that regulates its internal environment and tends to maintain a stable, constant condition of properties like temperature or pH...
by reintroducing normal bacterial flora from stool obtained from a healthy donor.
Description of procedure
The procedure itself sometimes involves a 5- to 10-day treatment with enemaEnema
An enema is the procedure of introducing liquids into the rectum and colon via the anus. The increasing volume of the liquid causes rapid expansion of the lower intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful peristalsis, a feeling of extreme urgency and...
s, made of bacterial flora from feces of a healthy donor, though most patients recover after just one treatment. The best choice for donor is a close relative who has been 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 nasogastric tube, delivering the bacteria directly to the small intestine. The two methods can be combined to achieve the best result. Regular checkups are required up to a year following the procedure.
A modified form of fecal bacteriotherapy (Autologous Restoration of Gastrointestinal Flora - ARGF) that is safer, more effective, and easier to administer is being developed. An autologous faecal sample, provided by the patient before medical treatment, is stored in a refrigerator. Should the patient subsequently develop C. difficile, the sample is extracted with saline and filtered. The filtrate is freeze-dried and the resulting solid enclosed in enteric-coated capsules. Administration of the capsules will restore the patient's own colonic flora and combat C. difficile. This procedure will avoid the hazards of standard FB, where infection from the donor could be transmitted to the patient and the requirement to deliver faecal samples into the duodenum via a nasal probe.
Theoretical basis
The hypothesis behind fecal bacteriotherapy rests on the concept of bacterial interference: using harmless bacteria to displace pathogenPathogen
A pathogen gignomai "I give birth to") or infectious agent — colloquially, a germ — is a microbe or microorganism such as a virus, bacterium, prion, or fungus that causes disease in its animal or plant host...
ic organisms. This approach to combating bacterial infections is not new, and has long been used in animals; for example, to prevent salmonellosis in chickens. In the case of pseudomembranous colitis
Pseudomembranous colitis
Pseudomembranous colitis, a cause of antibiotic-associated diarrhea , is an infection of the colon. It is often, but not always, caused by the bacterium Clostridium difficile. Because of this, the informal name C. difficile colitis is also commonly used. The illness is characterized by...
the pathogen is known (C. difficile
Clostridium difficile
Clostridium difficile , also known as "CDF/cdf", or "C...
), 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
Gut flora
Gut flora consists of microorganisms that live in the digestive tracts of animals and is the largest reservoir of human flora. In this context, gut is synonymous with intestinal, and flora with microbiota and microflora....
, 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. This may be considered an extension of probiotic
Probiotic
Probiotics are live microorganisms thought to be beneficial to the host organism. According to the currently adopted definition by FAO/WHO, probiotics are: "Live microorganisms which when administered in adequate amounts confer a health benefit on the host"...
research.
Effectiveness
Though the procedure has been used in the treatment of C. difficileClostridium difficile
Clostridium difficile , also known as "CDF/cdf", or "C...
infections for a number of years, the body of literature examining its efficacy currently consists only of observational studies, and no randomized controlled trials. Benefits of fecal bacteriotherapy include reducing the risk of cultivating antibiotic-associated resistance in the pathogenic bacteria displaced by the colonization and its purported effectiveness when antibiotic resistance is already in place. It is still considered a "last resort" therapy due to its relative invasiveness compared to antibiotics, the inherent risks of infection, lack of Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
coverage for donor stool screening and instillation procedure, and the absence of any effective means of ensuring that the donor stool is itself free of pathogens.
While its effects on ulcerative colitis have not yet been adequately researched, small case-studies report positive effects. A recent article by Borody et al. that details 6 cases of severe chronic ulcerative colitis
Ulcerative colitis
Ulcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the colon , that includes characteristic ulcers, or open sores. The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset...
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. The Sydney group also reports a case of presumed sclerosing cholangitis
Primary sclerosing cholangitis
Primary sclerosing cholangitis is a chronic liver disease caused by progressive inflammation and scarring of the bile ducts of the liver. The inflammation impedes the flow of bile to the gut, which can ultimately lead to liver cirrhosis, liver failure and liver cancer...
, a disease frequently associated with IBD
Inflammatory bowel disease
In medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...
, which recovered fully after the treatment.
Experiments are currently being conducted with Fecal bacteriotherapy as a treatment for Parkinsons disease.
History
It has been developed in recent years by Dr. Thomas J. BorodyThomas Borody
Thomas Borody is an Australian gastoenterologist based in Sydney who is noted for his work in novel therapies for gastrointestinal disorders.-Life:Thomas Julius Borody was born in Poland and migrated to Australia with his family in 1960...
and his team in Sydney, Australia, primarily as an alternative treatment for pseudomembranous colitis
Pseudomembranous colitis
Pseudomembranous colitis, a cause of antibiotic-associated diarrhea , is an infection of the colon. It is often, but not always, caused by the bacterium Clostridium difficile. Because of this, the informal name C. difficile colitis is also commonly used. The illness is characterized by...
. This disease is caused by C. difficile
Clostridium difficile
Clostridium difficile , also known as "CDF/cdf", or "C...
infection, and is typically treated with antibiotics.
See also
- Pseudomembranous colitisPseudomembranous colitisPseudomembranous colitis, a cause of antibiotic-associated diarrhea , is an infection of the colon. It is often, but not always, caused by the bacterium Clostridium difficile. Because of this, the informal name C. difficile colitis is also commonly used. The illness is characterized by...
- Ulcerative colitisUlcerative colitisUlcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the colon , that includes characteristic ulcers, or open sores. The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset...
- Irritable bowel syndromeIrritable bowel syndromeIrritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
- Inflammatory bowel diseaseInflammatory bowel diseaseIn medicine, inflammatory bowel disease is a group of inflammatory conditions of the colon and small intestine. The major types of IBD are Crohn's disease and ulcerative colitis.-Classification:...
- Helminthic therapyHelminthic therapyHelminthic therapy, a type of immunotherapy, is the treatment of autoimmune diseases and immune disorders by means of deliberate infestation with a helminth or with the ova of a helminth. Helminths are parasitic worms such as hookworms and whipworms....
External links
- Center for Digestive Diseases, Sydney, Australia
- How Microbes Defend and Define Us New York Times article from 2010 discussing fecal bacteriotherapy
- Fecal transplants to cure Clostridium difficile infection
- Don't poo-poo technique: Fecal transplant can cure superbug, doctors say
- Faecal transplant eases symptoms of Parkinson's
- Bacteriotherapy - Development and Delivery of a Treatment for Clostridium difficile
- Video: ABC TV Catalyst, 14 July 2011 - Fecal Bacteriotherapy for Clostridium difficile infection