Fecal transplant procedure?
May 31, 2019 1:53 PM Subscribe
I have a relative who is struggling with C. Diff but is reluctant to do a fecal transplant because she doesn’t know what the procedure entails. Can you help?
Is the donor stool available in pill form, or is it typically introduced rectally? Is one method more effective than another? What would be the least invasive way to accomplish this?
Any thoughts would be great so that I can put her mind at ease and get her some relief. Thanks!
Is the donor stool available in pill form, or is it typically introduced rectally? Is one method more effective than another? What would be the least invasive way to accomplish this?
Any thoughts would be great so that I can put her mind at ease and get her some relief. Thanks!
One point of anecdata:
A bit more than five years ago, my father-in-law suffered from a very rare autoimmune disease, which lead to severe kidney problems that required a long hospital stay until it could be diagnosed and treated properly with chemotherapy.
That lengthy stay lead him to unfortunately contract a case of C. diff. that did not respond to heavy antibiotics, which in turn lead to another hospital stay for dehydration.
The doctors at the hospital where he was treated seemed interested in the idea of doing a fecal transplant. I offered to "donate" a fecal sample and was accepted after some screening questions (had I taken antibiotics recently, had any other health issues, etc.).
I don't know if my particular specimen was administered (double-blind trial process and so on), but I believe he received treatment from one or another donor, rectally and under sedation (as would be done for a colonoscopy) and his symptoms subsided to the point where he could return home.
He had other serious health issues in his remaining years, sadly, but his C. diff. did not return, to my knowledge.
I'm not a doctor, I just have a biology background, but I suspect pills are probably being investigated because avoiding the colonoscopy route means less expense and no risk of intestinal perforation or sedation waking issues.
posted by They sucked his brains out! at 4:40 PM on May 31, 2019
A bit more than five years ago, my father-in-law suffered from a very rare autoimmune disease, which lead to severe kidney problems that required a long hospital stay until it could be diagnosed and treated properly with chemotherapy.
That lengthy stay lead him to unfortunately contract a case of C. diff. that did not respond to heavy antibiotics, which in turn lead to another hospital stay for dehydration.
The doctors at the hospital where he was treated seemed interested in the idea of doing a fecal transplant. I offered to "donate" a fecal sample and was accepted after some screening questions (had I taken antibiotics recently, had any other health issues, etc.).
I don't know if my particular specimen was administered (double-blind trial process and so on), but I believe he received treatment from one or another donor, rectally and under sedation (as would be done for a colonoscopy) and his symptoms subsided to the point where he could return home.
He had other serious health issues in his remaining years, sadly, but his C. diff. did not return, to my knowledge.
I'm not a doctor, I just have a biology background, but I suspect pills are probably being investigated because avoiding the colonoscopy route means less expense and no risk of intestinal perforation or sedation waking issues.
posted by They sucked his brains out! at 4:40 PM on May 31, 2019
Yep, it would be a colonoscopy type of treatment.
More anecdata:
In the case of my friend K. and her dad (he had C. diff post chemo), said friend was able to be the donor. Prior to donating, she was screened to make sure she wasn't an asymptomatic carrier of any bad pathogens. One treatment and her dad was cured.
At the very same time, I was on massive antibiotics as a result of a cat bite. The infection was in a tendon sheath in my hand, so it was slow to respond to meds. After 5 months of treatment, I got to the point where it seemed like C. diff. was a real possibility for me and I looked into FMT. I was fully ready to do the treatment if needed and was mentally going through my friends to figure out the best donor. I had already placed my friend K. high on my list when I found out she had helped out her dad. :)
posted by jenquat at 9:31 PM on May 31, 2019
More anecdata:
In the case of my friend K. and her dad (he had C. diff post chemo), said friend was able to be the donor. Prior to donating, she was screened to make sure she wasn't an asymptomatic carrier of any bad pathogens. One treatment and her dad was cured.
At the very same time, I was on massive antibiotics as a result of a cat bite. The infection was in a tendon sheath in my hand, so it was slow to respond to meds. After 5 months of treatment, I got to the point where it seemed like C. diff. was a real possibility for me and I looked into FMT. I was fully ready to do the treatment if needed and was mentally going through my friends to figure out the best donor. I had already placed my friend K. high on my list when I found out she had helped out her dad. :)
posted by jenquat at 9:31 PM on May 31, 2019
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An oral (pill) option is available through some of these trials (such as the trial going on run by Seres Therapeutics, or from Finch Therapeutics), though one is a rectal delivery (the Rebiotix trial). FMT is typically performed via colonoscopy, which requires sedation, but has the highest reported success rates of any delivery modality (85% by colonoscopy vs 50ish% by nasogastric tube/enema/capsule). However, those success rates aren’t well studied, and are likely overestimates.
My bias: I have worked at both OpenBiome (the stool bank that sells FMT material to doctors) and Seres (a pharma company running a clinical trial). If it were my grandma, I’d put her in a clinical trial, and ideally the Seres trial (even though I don’t work there anymore). All of this guidance assumes your relative is in North America.
posted by amelioration at 3:28 PM on May 31, 2019 [9 favorites]