Clostridium difficile, above, causes severe diarrhoea (Picture: Annie Cavanagh)

Would you be willing to have someone else’s blood coursing through your veins to help you stay alive?

Would you be happy to take someone’s kidney if your own one had failed?

Well then, what about this: Would you allow someone else’s poo to be put into your body to improve your quality of life?

We all take crap from people every day, but only in a non-literal sense. However, if you are suffering from severe diarrhoea brought on by Clostridium difficile infection, a faecal transplant may be your last hope for some kind of normality.


The procedure of faeces donation is increasingly seen by the medical world as a viable option to improve the lives of C. diff sufferers.



In a landmark study from the Netherlands, the results of which were published last month, 15 out of the 16 patients treated with a faecal transplant had their C. difficile resolved. In two other groups treated with antiobiotics, less than one in three patients were cured. In fact, the faecal transplant method was so effective that the study had to be stopped.

The study was led by Dr Josbert Keller, a gastroenterologist at the Hagaziekenhuis Hospital in The Hague who has overseen more than 100 faecal transplants.

In this case, the donor faeces was fed into the gut through a nasoduodenal tube which goes through the patient’s nose.

Within six hours of the donor producing the faeces, it is broken down into a liquid solution using saline before being pumped into the patient.

Once in the gut, the ‘good’ bacteria (microbiota or flora) from the donor faeces fights the C. difficile infection. With antibiotics, the drugs to treat C. diff can exacerbate the problem as they kill healthy as well as harmful bacteria in the gut.

‘It really works and it has been shown that it works,’ said Dr Keller.

‘It’s not difficult to convince the patient that he needs this treatment because the patient is already desperate after having four or five episodes of Clostridium difficile infection.’

‘The patients don’t see it as faeces – they see it as this kind of chocolate milk and they don’t smell it.

‘It falls through the small bowel. Most patients do have some kind of diarrhoea on the day of the infusion but that is very short and that is very mild and then the patients are cured. Most patients do not have diarrhoea from C. diff any more after the infusion.’

He said the major obstacles lay with the donor, who must be found and then must undergo a series of tests.

‘That is the major limitation of the treatment – there is still the theoretical possibility that you bring over bacteria or a virus or a parasite from the donor into the patient.’

He added: ‘The donor has to be there at the right time. The donor has to deliver the faeces at the moment that everybody is waiting for it. Sometimes there can be some logistical problems.’



Dr Keller said that, in the past, there had been resistance in the medical profession to the treatment, but things are changing.

‘It is very understandable that people thought this isn’t the way to go. Everybody will agree that this is not the nicest kind of treating someone. Some people will think it’s funny but if you’re a patient you don’t have a choice. But it’s not a nice way of treating a patient.

‘The resistance from the medical community will decrease now rapidly. It’s not only because this treatment works but it’s mainly because for those patients we really do not have another solution at this moment.’

Faecal transplants are already being considered for other conditions apart from C. difficile infection.

Dr Ailsa Hart, a consultant gastroenterologist at St Mark’s Hospital in London, has just completed a pilot study which used the procedure to treat those with inflammatory bowel disease.

The trial involved giving the transplant to those suffering from pouchitis. These are patients who have been treated for colitis – an inflammation of the colon – and are left with a surgically-created pouch which in turn can become inflamed. The results of the pilot scheme will be published later this week.

Despite the recent research, Dr Hart insists many questions still need to be answered about faecal transplants.

‘I think it’s got a lot of potential,’ she said. ‘But there is a huge amount of basic science that still needs to be understood about the role of the microbiota in health and different diseases.


‘It’s still a very blunt tool that is being used and we need to understand an awful lot more about the tool before it is advocated in any way in any particular disease state.

‘We don’t know as regards to donor transplants who are the right people to be giving stools to make sure we’re transplanting the right things in.

‘We don’t whether it should be frozen or whether it should be fresh transplants that should be used. Should these be given by enemas? Should they be given by a duodenal infusion? There are an awful lot of “don’t knows” about it.’

Dr Hart advocated the establishment of national registries of donors and recipients of faecal microbiota transplants in order to monitor if there are any adverse effects in the long term.

While the procedure to fight C. difficile with a faecal transplant is not widely available in Britain, it has been carried out here on patients on a number of occasions, including at Gartnavel General Hospital in Glasgow.

Professor Mark Wilcox, a microbiologist at the University of Leeds, is confident the procedure works.

‘There’s been, over the years, lots of interest in using probiotics to treat or prevent C.diff infection,’ he said.

‘Probiotics are organisms that can modify the behaviour of other organisms. The ultimate form of probiotic therapy is rather than guessing which one or ones of the gut bacteria are friendly bacteria, as opposed to unfriendly bacteria, you give all of them in the hope that the good ones will shine through.’


However, he also pointed out that questions remain about faecal transplants.

‘Whilst there’s some logic to it, it still leaves a lot to be desired. Scientifically, it does appear that it’s got merit, but practicality wise there are a lot of drawbacks, in terms of getting hold of your faecal sample, who you get it from and the counselling that’s involved.

‘There’s a lot of testing that has to go on to check that the donor has not got something unpleasant that you could risk giving to the recipient.’

But what does the future hold for the treatment? Prof Wilcox suggests it could go two ways. The first option is producing a faecal preparation which is pre-tested.

He added: ‘The better step – the step that will cost more money – is to dig deeper into the science here and try and work out of all these hundreds of thousands of different species of bacteria that go towards making up our gut flora. Which ones are the ones which are beneficial and which ones you just don’t need.

‘Then you would produce a cocktail of those good guys and produce a preparation of those. So instead of giving everything you just give the things that are needed.’

Scientists in Canada are already working on a synthetic solution, growing bacteria from a healthy stool sample and then sequencing its DNA to identify the good bacteria present. By combining these healthy bacteria, a cocktail can be concocted which could replace the poo transplant.

Dr Keller believes this kind of research is the way forward.

‘For those mixtures of bacteria, it’s really in a more experimental phase, but that’s the way to go,’ he said.

‘I hope that in ten years that nobody does a donor faeces infusion any more, but I don’t know what time it will take. This is a temporary solution. It’s the best we have but, of course, we do not want to do it always. We want to develop a mixture of bacteria that can cure patients.’