London Letter: Clinic pioneers treatment for gut illness
Innovative procedure tackles most common gut bug infection – Clostridium Difficile
Clostridium difficile is still the most common use for faecal transplant: it hits hundreds of thousands of people annually, causing serious diarrhoea and often death. Photogarph: The Irish Times
The Taymount Clinic in Hitchin, a commuter town in Hertfordshire, outside London, is happily moving home to Letchworth shortly, due to an increase in demand from patients.
Taymount is not your average clinic: it takes stool samples from “the healthiest of donors” and, following some processing, implants them into patients with gut ailments.
The process is more complicated, naturally. Donors – who are paid, it is understood – are checked monthly to make sure they have not picked up a communicable disease.
In the early days, the stool was transplanted entirely. Today, waste-food elements are extracted; the natural microbiotics left are then frozen, before later being implanted in another’s gut.
Known as faecal microbiota transplantation, the results can be dramatic. “With any illness, the first thing to do is to sort out the gut,” says Taymount co-founder Glenn Taylor in a promotional video.
The history of faeces being useful for health dates back centuries: The Bedouins believed in eating “fresh, warm camel” dung to fend off dysentery. German Afrika Corps soldiers began to believe in it during the Nazis’ North African campaign, concluding that Bacillus subtilisin in the dung produced a helpful anti-microbe.
In the 1950s, surgeons in Colorado used faeces from a healthy donor to treat four patients, critically ill with what turned out to be Clostridium difficile. All four lived.
Clostridium difficile is still the most common use for faecal transplant: it hits hundreds of thousands of people annually, causing serious diarrhoea and often death.
Not always a cureAntibiotics work for some, though the cure often destroys the patient’s entire natural gut flora. Some people end up with C difficile coming back again and again.
Four years ago, the Mayo Clinic in Arizona performed its first colonoscopic faecal transplant on a patient seriously ill with C difficile, using stool donated by his brother.
“Unbelievably, the patient left the hospital 24 hours after the procedure, after having been bedridden for weeks,” says Dr Robert Orenstein of the Mayo Clinic. “That opened my eyes to the possibilities for helping others.”
In Hitchin, the Taymount Clinic promises gentleness, saying that each treatment last between 90 minutes and three hours, though the “more severe your symptoms are when you come to us”, the longer the session will last.
“We’ve developed our own method of transplanting via rectal catheter, which avoids the intrusive and often uncomfortable use of a colonoscope,” advises the clinic. That’s helpful, since many are more than a little squeamish.
The squeamishness is understandable. The faeces are ingested via a tube to the stomach or colon: “Unpleasant as it may sound, [it] works in around 90 per cent of cases,” says Taymount.
Oxygen exposureDonors follow a carefully- selected diet. The microbiota important for good gut health do not long survive exposed to oxygen, so “we collect the donor material under deoxygenated conditions, transporting in an insulated, sterile saline solution”.
Once there, the stool is processed in a nitrogen-rich environment. Donations not needed immediately are fast-frozen. The donor is again tested “to ensure the continuing safety and quality of the implants”, says Taymount.
However, Glenn Taylor says that faecal transplants are useful far beyond Clostridium difficile. He mentions inflammatory bowel disease, Crohn’s diseases, even multiple sclerosis and chronic fatigue.
Taymount treats 400 patients a year. To date, it has carried out some 4,000 implants.
Recently the clinic has begun to treat people with coeliac disease. Some medics in the US quoted by the New Scientist remain cautious of this, concerned that more than just good bacteria could be transmitted
In a message to doctors, however, Taymount says that a diminishing number of new drugs are coming onto the market, thus forcing doctors “to think outside the box” to find solutions for their patients.
Faecal transplants are “completely logical” for food microbiologists, it says: “Why wouldn’t you transplant the fully compiled healthy gut flora from a healthy human into a grossly bacterially- compromised gut?”
Taylor is definitely convinced: “It seems to work extraordinarily well.” He points to the fact that he and his wife and co-founder, Enid Taylor, tested it in themselves when they opened in the Hertfordshire town.
Meanwhile, the perfect donor, say researchers in Canada, is someone who has no chronic illnesses, is of the proper weight and “doesn’t drink, smoke, take drugs and had never been exposed to antibiotics”.