An effective, if unpalatable, gut function treatment

A significant breakthrough in the science of faecal therapy

 

The results are in for the first trial of a “poop pill”, which represents a significant breakthrough in the science of faecal therapy. True, it will take more than a spoonful of sugar for this particular medicine to go down, but for many of us it may be preferable to the alternative.

Recurrent infection from the bug Clostridium difficile causes debilitating diarrhoea. While antibiotic treatment is effective for many, relapse rates are high, with the result that some people end up needing surgery to remove part of their large bowel.

Certain strains of C.diff have become resistant to antibiotics, which in any case tend to kill off the beneficial microbes that inhabit our gut, many of which help protect us from other diseases. So the development of faecal macrobiota therapy (FMT), which helps restore the normal balance of beneficial microbes with success rates of about 90 per cent, is a major breakthrough in the treatment of C. diff infection.

Traditionally, surgeons who carried out ileal (small bowel) transplants sterilised the donor ilea before transplantation in the recipient. However, the patients ran into problems linked to the absence of the normal gut flora in the transplanted intestines.

In response, one surgical team decided to leave some of the donor’s microbes within the ileum they were about to transplant. The recipient recovered normal gut function much quicker than those given the super- sterilised ilea.

Faecal transplants

This outcome prompted other researchers to experiment with faecal transplants. Studies showed that transplanting faecal material in liquid form from healthy people produced dramatic results in patients with C.diff. But delivering FMT in this way, either via the rectum or through a nasogastric tube is expensive, labour intensive and somewhat unpleasant.

So, the online publication last week of a paper in the Journal of the American Medical Association, which outlines the effectiveness of oral capsules containing FMT, marks a significant breakthrough.

Researchers at the Massachusetts General Hospital collected stool samples from healthy adult volunteers. After screening for infectious diseases, the samples were filtered, put into acid-resistant capsules and frozen for four weeks. They were then screened again for infection before being given to some 20 trial participants.

These individuals, aged from 11 to 84 and with persistent C.diff infection, then took 15 capsules each day for two days running. Fourteen of the 20 had complete resolution of their symptoms after a single round of treatment; the other six received a second course of FMT a week later. and in five of them symptoms resolved.

Using a parameter of infection recurrence eight weeks after treatment, the overall success rate was 90 per cent.

Commenting on the latest research, Dr Alan Coss, consultant gastroenterologist at the Galway Clinic, says research in the area is moving quite rapidly. “Recent studies suggest that more palatable treatment options may soon be available that address the safety and aesthetic concerns of faecal transplant, while maintaining high cure rates for severe or recurrent C.difficile infection.

“FMT also holds out promise for the treatment of other bowel conditions associated with suspected disturbances of the gut microbiome, including ulcerative colitis, Crohn’s disease, and irritable bowel syndrome, although it is early days,” Dr Coss says.

Combating the “yeuch” factor is important for FMT to become more acceptable aesthetically. It helps that the capsules are frozen, making it difficult to identify the contents. Mind you, aesthetics hasn’t stopped some gung-ho home practitioners of faecal transplants.

The practice is not without its dangers, as many of us are symptomless carriers of bacteria, viruses and even parasites. By not thoroughly screening donors, the purveyors of home-brew faecal macrobiota therapy have caused some severe infections in recipients.

It’s fair to say that most of us contemplating faecal macrobiota therapy would prefer a more palatable and less risky option.
 

Dr Muiris Houston is a specialist in general practice and occupational medicine and a medical education consultant. mhouston@irishtimes.com / muirishouston.com

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