By MARILYNN MARCHIONE | AP Chief Medical Writer
Hold your nose and don't spit out your coffee:
Doctors have found a way to put healthy people's poop into pills that
can cure serious gut infections – a less yucky way to do “fecal
transplants.” Canadian researchers tried this on 27 patients and cured
them all after strong antibiotics failed to help.
It's a gross topic but a serious problem. Half a
million Americans get Clostridium difficile, or C-diff, infections each
year, and about 14,000 die. The germ causes nausea, cramping and
diarrhea so bad it is often disabling. A very potent and pricey
antibiotic can kill C-diff but also destroys good bacteria that live in
the gut, leaving it more susceptible to future infections.
Recently, studies have shown that fecal transplants
– giving infected people stool from a healthy donor – can restore that
balance. But they're given through expensive, invasive procedures like
colonoscopies or throat tubes. Doctors also have tried giving the stool
through enemas but the treatment doesn't always take hold.
There even are YouTube videos on how to do a
similar treatment at home via an enema. A study in a medical journal of
a small number of these “do-it-yourself” cases suggests the approach is
safe and effective.
Dr. Thomas Louie, an infectious disease specialist
at the University of Calgary, devised a better way – a one-time
treatment custom-made for each patient.
Donor stool, usually from a relative, is processed
in the lab to take out food and extract the bacteria and clean it. It is
packed into triple-coated gel capsules so they won't dissolve until
they reach the intestines.
“There's no stool left – just stool bugs. These
people are not eating poop,” and there are no smelly burps because the
contents aren't released until they're well past the stomach, Louie
Days before starting the treatment, patients are
given an antibiotic to kill the C-diff. On the morning of the treatment,
they have an enema so “the new bacteria coming in have a clean slate,”
It takes 24 to 34 capsules to fit the bacteria
needed for a treatment, and patients down them in one sitting. The pills
make their way to the colon and seed it with the normal variety of
Louie described 27 patients treated this way on
Thursday at IDWeek, an infectious diseases conference in San Francisco.
All had suffered at least four C-diff infections and relapses, but none
had a recurrence after taking the poop pills.
Margaret Corbin, 69, a retired nurse's aide from Calgary, told of the misery of C-diff.
“It lasted for two years. It was horrible. I
thought I was dying. I couldn't eat. Every time I ate anything or drank
water I was into the bathroom,” she said. “I never went anywhere, I
stayed home all the time.”
With her daughter as the donor, she took pills made by Louie two years ago, and “I've been perfectly fine since,” Corbin said.
Dr. Curtis Donskey of the Cleveland Veterans
Affairs Medical Center, who has done fecal transplants through
colonoscopies, praised the work.
“The approach that Dr. Louie has is completely
novel – no one else has done this,” he said. “I am optimistic that this
type of preparation will make these procedures much easier for patients
and for physicians.”
The treatment now must be made fresh for each
patient so the pills don't start to dissolve at room temperature,
because their water content would break down the gel coating. Minnesota
doctors are testing freezing stool, which doesn't kill the bacteria, so
it could be stored and shipped anywhere a patient needed it.
“You could have a universal donor in Minnesota
provide a transplant for someone in Florida. That's where we're
heading,” Donskey said.
Other researchers are trying to find which bacteria
most help fight off C-diff. Those might be grown in a lab dish and
given to patients rather than the whole spectrum of bacteria in stool.
The hope is “we could administer that as a probiotic in a pill form,” Donskey said.
Louie sees potential for the poop pills for other
people with out-of-whack gut bacteria, such as hospitalized patients
vulnerable to antibiotic-resistant germs.
“This approach, to me, has wide application in medicine,” he said. “So it's not just about C-diff.”
CDC on C-diff: http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html
Follow Marilynn Marchione on Twitter at http://twitter.com/MMarchioneAP
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