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Ancient transplant used as recent treatment for type of colitis

Tim Sandle

Donating blood and organs, if possible, is encouraged in the medical world to save lives. But recently, medical professionals may also be looking for a new type of donor—fecal.

Fecal transplantation dates back to 4th century China, according to the Fecal Transplant Foundation, and is a recent, but often effective, treatment for a specific type of colitis. To explain fecal transplantation this week on “Take Care,” is Dr. Rajeev Jain. Jain is a partner at Texas Digestive Disease Consultants, the chief of gastroenterology at Texas Heath Dallas, and is a clinical assistant professor of medicine at University of Texas Southwestern Medical School.

So what is this procedure that seems so off-putting?

According to Jain, a fecal transplant is like any other transplant; taking fecal matter from one person and putting it in the digestive tract of another. Patients who benefit from a fecal transplant are those who suffer from Clostridium difficilecolitis, or C. diff for short.

C. diff is a natural bacterium our body grows, but when growth gets out of control it can cause illness, says Jain.

“In many patients, it’s difficult to treat and cure with our standard treatments these days,” Jain said.

Although C. diff can be treated with antibiotics, this is also what can cause overgrowth of the bacterium in the first place. In fact, Jain says that one out of three patients who are treated for C. diff with antibiotics will end up with the infection again. So by transplanting healthy fecal matter into the gastrointestinal (GI) tract of an infected person, it rebalances the gut microbiome and provides a 90-95 percent cure rate, according to Jain.   

“You restore the normal flora and fauna in the colon,” Jain said.

Although you might think donating fecal matter would be one of the simplest medical donations you could make, Jain says there is actually a lot that goes into it.

“They really go through a lot of assessment,” Jain said. “The stool specimen that comes from the donor is checked for infection in the stool, blood tests are done to check for infection in the bloodstream; such as HIV or hepatitis B and C. Then those patients are also assessed to make sure that they don’t have autoimmune disorders or anything else significant that could be transmitted from the donor to the patient.”

Once a donor is thoroughly assessed, Jain says there are a couple different methods for the transplant. These include a tube that runs from the nose to the GI tract, an enema, or a colonoscopy. Jain also said there are companies working toward formulating a capsule that can be taken orally. Ingesting someone else’s stool by mouth may sound gross, but Jain says this form of the transplant would be the simplest and least invasive to the body.

According to Jain, there are about half a million new cases of C. diff infection in the U.S. every year—a number that’s doubled over the last few decades. He says most cases are mild with symptoms that are manageable, but there are severe cases that can cause extreme discomfort.

“This is where [fecal transplant] has been an amazing change in our ability to treat those patients,” Jain said.

Although a fecal transplant could be life changing for some people, Jain says there is still a lot to learn and the treatment is still under FDA investigation.

“When you change the microbiota of one person to another person, there is potential that it could cause changes in other parts of the body. We are still learning how important the gut microbiota is to other functions,” Jain said.

To help further this research, Jain says the American Gastroenterological Association is working on creating a registry of patients who undergo fecal transplant to make sure the procedure doesn’t cause any major health alterations.