Paging Dr. Frischer: Fecal transplant

Welcome to the 21st Century, when one person’s poop is another’s medicine! 

Yes, human feces are being implanted from one person into another. Fecal Microbiota Transplant (FMT) allows a broad spectrum of microorganisms to fight off disease and prevent future infections.

At first glance, someone else’s stool would appear to be a source of infection, not a treatment. However, microorganisms living in the human gut play a critical role in the body’s defenses against infection, and provide a solution to the rapidly worsening problem of antimicrobial resistance. Germs are getting smarter about how to beat antibacterial and antiviral medicines. Using bacteriotherapy, potentially helpful bacteria are transplanted into another person’s infected bowel, with the goal of fighting off harmful germs. This not only treats the infection, but also avoids the elimination of beneficial natural bacteria. This is not the case with antibiotics.

The science is actually far from new. The first examples of FMT can be traced to 4th Century China, where documents make reference to the use of stool transplantation to treat food poisoning and diarrhea. In the 16th Century, Li Shizhen, an herbalist, treated abdominal diseases using remedies referred to as “yellow soup” and “golden syrup,” that contained fresh, dried or fermented stool. Veterinary medicine utilized a treatment that transferred microorganisms from the stomach of healthy animal donors to sick animals. During World War II, German soldiers used a Bedouin remedy for bacterial dysentery: consuming fresh camel dung.

Today, FMT begins with the selection of a healthy donor who contributes a stool sample. Fresh stool is used within six hours, although frozen stool has also been used. The stool is then mixed with a solution and strained. It is placed into the patient’s colon by using an enema, colonoscopy, or sigmoidoscopy.

The primary use for FMT, so far, is to treat a potentially fatal infection known as clostridium difficile (C. diff) colitis. C. diff occurs due to a shortage of healthy intestinal bacteria in the body. This healthy flora normally triggers the immune system and helps with the digestion and absorption of food. C. diff attacks the lining of the intestine, causing diarrhea. It usually starts when antibiotics are taken to treat another infection. Antibiotics are lifesavers that kill off one pathogen, but often result in collateral damage by wiping out good bacteria as well. In this case, the antibiotic kills the pathogen, which is the intended goal, but also kills off other protective bacteria in the gut. This leads to the C diff infection. As a result of our common use of antibiotics, the incidence, severity, and mortality of C. diff is increasing. Using FMT along with antibiotics to restore balance in the gut is a clever and effective approach. Research shows that it is safe, inexpensive, and 90% effective with just one treatment.
It’s possible that FMT may be effective for other conditions as well. It has been used to treat ulcerative colitis, as well as non-gastrointestinal conditions including various autoimmune disorders, obesity, metabolic syndrome and diabetes, multiple sclerosis, and Parkinson’s disease. Research is being conducted.

Note that the FDA has not yet fully approved Fecal Microbiota Transplant. In 2013 the FDA allowed its use for patients with C diff. infections who were not responding to standard therapies. In 2014, the FDA issued an update allowing doctors to use this treatment at their own discretion. Still, many questions remain unanswered. Precisely how does bacteria from transplanted stool alter the recipient’s gut microbiota? Out of trillions of bacteria contained in stool, which particular ones are beneficial, which are dangerous, and which have no real effect? Who is the ideal donor, what is the optimum method of stool preparation, and what is the best route of administration?

Stay tuned. Details of Fecal Microbiota Transplant are being worked out, and who knows who among us will be among the fortunate ones to benefit from this surprising, but cutting-edge, treatment!

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.