Fecal bacteriotherapy

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Fecal bacteria at 10,000× magnification

Fecal bacteriotherapy, also known as fecal transfusion, fecal transplant, or human probiotic infusion (HPI), is a medical treatment in which bacteria from feces of a healthy person are transferred into the large bowel and rectum of a patient. It is an alternative treatment for patients with pseudomembranous colitis (caused by Clostridium difficile), ulcerative colitis and irritable bowel syndrome.

Description of procedure

The procedure itself involves a 5 to 10 day treatment with enemas, made of bacterial flora from feces of a healthy donor (who needs to be 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. Regular checkups are required up to a year following the procedure.

Theoretical basis

The hypothesis behind fecal bacteriotherapy is that ulcerative colitis may, like in the case of pseudomembranous colitis, be a previous infection by a still unidentified pathogen which somehow damages the healthy bacterial flora of the colon, causing a bacterial imbalance, which then proceeds to reinfect and damage the colon in an endless cycle which can be broken by "recolonizing" the colon with bacteria from a healthy bowel[1]. This may be considered an extension of probiotic research.

Effectiveness

The procedure has been used to successfully cure C. difficile infections for a number of years, with a success rate of nearly 95% according to some sources[2][3][4].

While its effects on ulcerative colitis have not yet been adequately researched, small case series suggest it has positive effects. A recent article by Dr. Borody in which he details 6 cases of severe chronic ulcerative colitis 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[5]. The Sydney group also reports a case of presumed sclerosing cholangitis, a disease frequently associated with IBD, which recovered fully after the treatment.

History

It has been developed in recent years by Dr. Thomas J. Borody and his team in Sydney, Australia, primarily as an alternative treatment for pseudomembranous colitis. This disease is caused by C. difficile infection, and is typically treated with antibiotics.

See also

References

  1. Borody T, Warren E, Leis S, Surace R, Ashman O, Siarakas S (2004). "Bacteriotherapy using fecal flora: toying with human motions". J Clin Gastroenterol. 38 (6): 475–83. PMID 15220681. PDF
  2. Schwan A, Sjölin S, Trottestam U, Aronsson B (1983). "Relapsing clostridium difficile enterocolitis cured by rectal infusion of homologous faeces". Lancet. 2 (8354): 845. PMID 6137662.
  3. Paterson D, Iredell J, Whitby M (1994). "Putting back the bugs: bacterial treatment relieves chronic diarrhoea". Med J Aust. 160 (4): 232–3. PMID 8309401.
  4. Borody T (2000). ""Flora Power"-- fecal bacteria cure chronic C. difficile diarrhea". Am J Gastroenterol. 95 (11): 3028–9. PMID 11095314. PDF
  5. Borody T, Warren E, Leis S, Surace R, Ashman O (2003). "Treatment of ulcerative colitis using fecal bacteriotherapy". J Clin Gastroenterol. 37 (1): 42–7. PMID 12811208. PDF

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