News topic: Fecal transplants
January 25, 2011
By Christa Lawler
Duluth News Tribune
Patricia Shoop had chronic diarrhea, she was dehydrated and she had lost 16 pounds. The self-described glass-half-full woman, a 74-year-old from Minnetonka who teaches English as a Second Language twice a week and regularly swims, could hardly move.
She had been diagnosed with Clostridium difficile, a disruption of the bacteria in the colon that can occur when a patient has been on antibiotics. The drugs kill off both the bad and good bacteria in the colon. The walls of the intestines also can break down. It can be fatal.
“I thought maybe I was dying,” Shoop said. “I wasn’t eating. That’s all I did is have diarrhea. It’s pretty yucky. I thought: ‘I don’t care how much it costs. We’ll mortgage the house, do anything to make it better.’ ”
Her situation was so bad that when a childhood friend mentioned the words “fecal transplant,” the rare and somewhat controversial treatment sounded more like a much-needed solution than the punch-line to school bus humor.
In early December, Shoop had a fecal transplant at Essentia Health Duluth Clinic.
Gastroenterologist Dr. Tim Rubin said that in more than a decade, 109 fecal transplants have been performed at the clinic with an 85 percent success rate. He estimated that just six to 12 other hospitals in the country treat C. difficile in this way. Dr. Johan Bakken and Dr. Johannes Aas, both with roots in Scandinavia where fecal transplants are more prevalent, introduced the procedure into their general practices here in 1999. Rubin began work in this area about five years ago.
THE PROCEDURE
The colon is a natural reservoir for bacteria, and when it is thrown off balance, C. difficile is able to grow, leading to uncomfortable symptoms. With a fecal transplant, doctors introduce a donor’s healthy stool — literally a man-made probiotic — to the patient’s body.
In Shoop’s case, her husband, Bob, was in the hot seat.
The night before the procedure, Patricia Shoop said she was worried about the pressure on her husband to be able to go at “go time.”
“I said: ‘You’re going to have steak, and chocolate and wine,’ ” she said.
Bob Shoop’s donation was mixed up in a lab to a liquid that Rubin describes as the consistency of chocolate milk.
A tube was threaded through Patricia Shoop’s nose and down her throat into her stomach. The doctor used a syringe to send the liquid through the tube and into the upper GI tract. Shoop would eventually push it through her colon.
The entire outpatient procedure took about 20 minutes, during which Shoop was awake. There is no smell and no taste. The mixture is cold, she said. The worst of it is the uncomfortable feeling of the tube in the nose.
Shoop felt better three days after the fecal transplant. Within a week, she was eating normally. Last week she was checked for signs of infection and came out A-OK.
“I’ve been pooping like everyone else ever since,” she said, and laughed. “How’s that for a testimony.”
WHY CONTROVERSIAL
Of course, there is a certain amount of yuck involved with fecal matters. Dr. Charles Gessert, a senior research scientist at Essentia Institute of Rural Health, said these are obviously the concerns of people who have never had C. difficile.
“The people who are well have the luxury of such fastidiousness,” he said.
Last week, a report out of British Columbia featured a hospital where administrators had asked doctors to stop performing fecal transplants at the facility.
“Patient safety is our primary concern. The safety of fecal transplants has not been adequately studied,” according to the statement from Burnaby Hospital of Burnaby, B.C. “There must be strict controls to ensure other serious infections are not passed to the patient inadvertently.”
Gessert said these concerns are addressed by finding a donor from within the same household, who has similar flora because they are exposed to the same conditions, people, pets and hygiene.
There has not been a large enough body of research behind the procedure for Food and Drug Administration approval, he said. And getting that research done could be tricky.
“Human stool is never going to be manufactured by a pharmaceutical company,” Gessert said. “No profit is going to be made.”
This story was in the January 23,2011 edition of the Duluth (Minn.) News Tribune.
