Fecal transplants provide unexpected cure for C. diff

Oct. 25--Deanne Blomstrom's active retirement -- biking with her husband, aerobics at the community center, swimming in her backyard pool -- came to a screeching halt after she contracted bacterial meningitis in February.

But it wasn't the meningitis, which she overcame with help of powerful antibiotics, that was the problem. It was what came after: the clostridium difficile, or C. diff. The antibiotics used to treat the meningitis killed the good bacteria in her colon, which allowed antibiotic-resistant C. diff -- a very bad bacteria indeed -- to take over.

The 76-year-old Lower Saucon Township resident was stricken with painful chronic diarrhea that rendered her listless and fearful of leaving the house. Her C. diff infection persisted for months with no end in sight. Additional antibiotics proved futile. Such cases can be fatal; C. diff kills 14,000 Americans a year. The ailing grandmother was losing hope when her doctor proposed a radical new treatment: a fecal microbiotal transplantation.

"I thought, 'Eww. How disgusting!'" Blomstrom recalled.

A fecal transplant, as it's often called, is exactly what it sounds like. One person's, um, poop is put into another person's body. It works, scientists theorize, by re-introducing good microbes into the gut, which then out-compete and suppress the bad ones, such as C. diff.

The medical establishment has come to recognize the potential of FMT only in recent years, and two months ago St. Luke's University Health Network, which treated Blomstrom, became the first health care provider in the Lehigh Valley to offer it.

"It's a relatively simple procedure to do, so I said, 'Why don't we offer it,' " St. Luke's gastroenterologist Berhanu Geme said.

St. Luke's was followed by Lehigh Valley Health Network, whose doctors performed their first fecal transplant Monday.

LVHN gastroenterologist Hiral Shah said the network decided to offer FMT in response to popular demand.

"We have patients that have had C. diff for five years. ... They are very ready," he said. "We've been wanting to do it for a while. We just needed to do our due diligence."

Traditional medicine has made use of fecal matter for millennia. It was, for example, the key ingredient in "yellow soup," which fourth-century Chinese drank as a treatment for abdominal pain. And even in the United States, at least one doctor was experimenting with fecal transplants as far back as the late 1950s.

Since then, scientists have learned more about the microbiota, or microorganisms, that populate the human body. In doing so, they've gained an appreciation for just how much they still don't know.

The microbial cells in each of us, it turns out, make up more of us than do our own cells, outnumbering the human cells by a ratio of 10-to-1. And though the causality is poorly understood, recent studies suggest these cells -- or a lack of them -- might contribute to a wide range of health problems including diabetes, rheumatoid arthritis, muscular dystrophy, multiple sclerosis, fibromyalgia and even mental disorders such as depression and autism.

As the title of one recent academic paper put it: "The Human Intestinal Microbiome: A New Frontier of Human Biology."

The big breakthrough in C. diff treatment was reported by the New England Journal of Medicine in 2013. Researchers in the Netherlands conducted a randomized controlled trial comparing the effectiveness of fecal transplants to that of antibiotics. With a near-perfect success rate, the fecal transplants worked so much better that the trial was halted on the grounds that denying the transplants to patients who had been assigned antibiotics would be unethical.

Widespread adoption of FMT for patients with antibiotic-resistant C. diff might have followed immediately if not for questions about the acquisition of donor material.

Dr. Camille Eyvazzedeh, St. Luke's chief of colorectal surgery, looked into the matter and quickly found himself wading into a logistical thicket: "The donor must be cleared out by multiple tests -- no parasites, no recent antibiotics. ... Testing for that donor became very, very expensive. ... And insurance wouldn't cover it."

Eventually, St. Luke's, along with LVHN, turned to OpenBiome, a "public stool bank" in Boston. Tapping a network of donors who have undergone a battery of health tests, the nonprofit distributes frozen preparations of screened and filtered human stool. (Each preparation, which comes in a cylinder, used to cost less than $200, though the price has recently risen, according to doctors.)

OpenBiome was founded in 2012 by a Massachusetts Institute of Technology graduate student who had witnessed a friend recover from C. diff after a fecal transplant. Because the friend was unable to find a hospital that offered the procedure, he did it himself -- using his roommate's feces and an enema kit.

Such is the anguish and desperation of some suffering from C. diff that they're willing to resort to such measures.

In the spring, Blomstrom had to inform a friend that she would be unable to join her for their annual trip to Florida.

"I was afraid to go anywhere, because I didn't know if I was going to have another episode," she said. "It was just very frustrating."

And by summer, her husband was doing most of the cooking and cleaning because she lacked the energy to help out, she said: "Even just going to the grocery store was an effort."

After several rounds of antibiotics failed to control her C. diff, her doctor told her about FMT.

"I was amazed when I heard about the procedure. I just couldn't believe it. It's not something you hear about every day," the former executive secretary recalled. "And the more I learned about it, the more I was intrigued and wanted to have it done -- even though it sounds disgusting."

The procedure seemed so sci-fi she assumed she'd have to travel to some far-off locale to have it done. She was thrilled to find out St. Luke's would soon be offering it.

As the day of her transplant approached, she told her friends what she was doing.

"They would say, 'What? What is it called?' And then when I explain it, they were dumbfounded: 'You must be kidding! They really do that?'" she said.

Fecal transplants can be administered orally. Massachusetts General Hospital has developed a method by which fecal material is delivered via a capsule that is swallowed.

Both St. Luke's and LVHN have opted for the other approach -- a colonoscopy, an outpatient procedure in which a tube is passed through the anus.

"We go in with donor fecal matter that is dissolved in water and spray it in the large and small bowel," Eyvazzedeh explained.

Several days later, Blomstrom had her first normal bowel movement in months. She was cured -- and awed.

"It's amazing," she said. "Who ever thought they could do that?"

[email protected]

610-820-6130

ABOUT FMT

--The body contains 10 times more bacterial cells than human cells, many of which are linked to good health.

--Antibiotics wipe out helpful bacteria, leading people susceptible to Clostridium difficile, or C. diff, infections.

--Through fecal microbiotal transplantation, healthy stool is transplanted into the colon by colonoscopy, nasoenteric tube or capsules.

--FMT aims to repopulate the system with micro-organisms needed for a healthy gut.

--FMT is considered for patients who have not improved after antibiotic treatment.

--In those patients, FMT has been more then 90 percent effective.

--The procedure poses some risks, including that tests may fail to detect a pathogen in donor stool.

Source: OpenBiome, a Boston nonprofit set up to provide safe access to FMT

ABOUT C. DIFF

Clostridium difficile is a bacterium picked up from contaminated surfaces

About 250,000 people need hospital care for C. diff infections each year.

At least 14,000 people die from those infections

Older adults, especially those taking antibiotics, are most at risk

Symptoms include watery diarrhea for several days, fever, nausea and abdominal pain

To prevent C. diff, take antibiotics only as prescribed

Source: Centers for Disease Control and Prevention

___

(c)2015 The Morning Call (Allentown, Pa.)

Visit The Morning Call (Allentown, Pa.) at www.mcall.com

Distributed by Tribune Content Agency, LLC.