Demonstrating that even in medicine, "one man's trash is another man's treasure," patients with debilitating diarrhea are finding relief, if not cures, after receiving bacteria-rich stool from the guts of healthy donors, usually close relatives.
Despite the gross-out factor, fecal transplants are simple enough to perform at home using such inexpensive tools as a bottle of saline, a 2-quart enema kit from the local drugstore and a standard kitchen blender.
"Some of my patients tell me within three hours of having this that they feel better," said Dr. Lawrence J. Brandt, emeritus chief of gastroenterology at Montefiore Medical Center in the Bronx, N.Y., who has performed about 25 fecal transplants since 1999.
The approach, also called fecal bacteriotherapy, is hardly new. Dr. Ben Eiseman, the longtime chief of surgery at Denver General Hospital, reported in the Journal of Clinical Gastroenterology in 1958 that enemas containing feces from healthy colons successfully replenished good digestive bacteria in patients suffering from pseudomembranous colitis, a painful colon inflammation associated with a bacterium called Clostridium difficile. Dr. Thomas J. Borody, from the Centre for Digestive Diseases in Sydney, Australia, reported in the same journal in 2003 that "human probiotic infusions" reversed ulcerative colitis in six patients, each of whom had been sick at least five years with the inflammatory condition. All remained disease-free in one to 13 years of follow-up.
In recent years, the number of chronic infections with C. diff has increased, often from prolonged antibiotic use and growing antibiotic resistance, especially among the elderly and those in hospitals and long-term care facilities. That has driven renewed interest in fecal transplantation, although it's still not covered by health insurance plans.
North American gastroenterologists and infectious disease experts, mindful that the technique has been used in Europe, have been offering it as last-ditch therapy for patients wasting away from debilitating diarrhea that hasn't responded to even the most powerful and most expensive antibiotics, such as vancomycin.
Dr. Alexander Khoruts, a gastroenterologist at the University of Minnesota, reported in the Journal of Clinical Gastroenterology in June about a desperately ill C. diff patient cured within a day of receiving an infusion containing fecal bacteria from her husband. Khoruts and his colleagues demonstrated that her husband's healthy bacteria repopulated her gut and made it healthy, too.
Doctors infuse patients' colons using an enema or colonoscope (and sometimes the stomach using a nasogastric tube) with solutions of water or saline spiked with donor feces that have been screened for parasites, HIV, hepatitis, and other illness-causing microbes. They suggest donors should be someone you know and trust, like a spouse, a parent or a child, although a few institutions are experimenting with donations collected from healthy men or women who have been tested and found free of major diseases.
"This form of therapy has now reached primetime," Dr. Martin H. Floch, a digestive disease specialist at the Yale School of Medicine, declared in an editorial accompanying three studies of fecal transplantation in the September 2010 issue of the Journal of Clinical Gastroenterology. "Although there are some skeptics, it is clear from all of these reports that fecal bacteriotherapy using donor stool has arrived as a successful therapy."