rectal bulb syringe

(RECENT UPDATES ARE AT THE BOTTOM OF THE POST. MOST RECENT UPDATE AS OF 5/2/12.)

I live for this kind of stuff.

Slate online published an article a couple days ago titled The Enema of Your Enemy is Your Friend by Emily P. Walker. It reveals an unusual, frontier-type of treatment for an intestinal infection called Clostridium difficile that’s killed a lot of people over the years, and which 1.3 percent of patients are estimated to contract during a hospital stay.

Death by diarrhea. Not a fun way to go.

The traditional treatment for C. diff is a course of antibiotics but for the unlucky who fail to respond, fecal implants are another up and coming possibility. And before you wrinkle your nose and shake your head in disgust please consider that, in the small amount of documented research available so far, the outcomes are surprisingly good. From the article:

“It’s true there’s been no major clinical trial of fecal transplants, but the procedure appears in the medical literature at least as far back as 1958… Now we’re beginning to see some more extensive studies. Mark Mellow, a gastroenterologist at INTEGRIS Health in Oklahoma City, recently presented a paper showing that 15 out of 16 C. diff patients whom he’d provided with a fecal transplant remained disease-free after five months. Several other papers presented at the meeting showed similar positive effects, and in every case, symptoms disappeared almost immediately after the transplant.”

Evidently, it works because the foreign feces helps to repopulate friendly flora in the infected intestines. (Want to know the best feces to use? Borrow it from a person who lives with you. Their flora and your flora are the most likely to be a good match.) In a clinical setting the donated matter is first screened for disease and then mixed with a saline solution to the consistency of a “milkshake.” (The article is not only informative, it’s fun to read.) Then it’s pumped into the colon where it does it’s magic.

But there’s also an alternative:

“And then there’s the do-it-yourself crowd. All you need is a bottle of saline, a 2-quart enema bag, and one standard kitchen blender. Mike Silverman, a University of Toronto physician who wrote up a guide to homespun fecal transplants for the journal Clinical Gastroenterology and Hepatology, says it’s entirely safe to do the procedure this way, provided that a doctor gets involved at some point to screen the donor sample. He felt he needed to draw up the instructions because administrators at his hospital wouldn’t allow their doctors to perform a procedure that hasn’t been validated in a large, peer-reviewed study.”

But as Ms. Walker points out in the article, these studies are proving hard to come by. Pharmaceutical companies not only have little reason to shoulder the substantial costs involved (there’s not enough profit potential for them), there’s actually a disincentive; a natural remedy like this would replace an antibiotic treatment.

Gotta love our health care system’s fabulous cast of skewed incentives.

Needless to say, I’m endlessly fascinated when conventional medicine turns off the beaten path to consider the unusual. If this treatment turns out to be as successful as it looks like it could be, it would place it right up there with the simple elegance of biosurgery; the use of maggots in destroying necrotic tissue in a slow or non-healing wound.

My hope is always that the adversarial stance so often adopted between different healing modalities will eventually soften and reverse. It sure seems like the more hands we have on deck, the more solutions we’ll find for not only treating illness, but increasing health, thereby enriching everyone’s quality of life.

UPDATE: October 29, 2011

It looks like this treatment may be starting to get the acceptance (and application) it deserves. I just found a headline article on msn.com called Sounds gross, works great: Fecal transplants cure nasty C. diff infections citing the benefits and growing use of fecal transplants. The article mentions a success rate of 90% for the treatment (yowza!) yet says the transplants are still looked at as a “treatment of last resort.” I wonder how much of that is due to doctor’s skepticism and how much is patient’s resistance?

In any case it’s interesting to note how quickly fecal transplants are gaining traction as a viable treatment. With C. diff infections on the rise, the availability of a treatment with a 90% success rate is a godsend.

UPDATE: July 6, 2011

And now, a recent positive write-up in a professional journal! The journal Pediatrics published an article on June 14, 2011 covering the case of a child who was successfully treated with a fecal implant.

For those researching, here’s an online physician’s resource called HCP Live, with a couple of other potentially valuable links. Good luck!

UPDATE: March 24, 2011

Because I’m getting a lot of hits on this post I thought I’d update it whenever new information comes in. Today, I received a comment from Kathy Suszek who is a nurse case manager “working with a gentleman who just had the fecal implant done, he tells me his results are “wonderful”. Had 1-2 loose bowel movements, in the past few wks, but much improvement. Just wanted to share news that is positive for a change. His provider has had 14-out of 14 success stories.”

UPDATE: May 2, 2012

Here’s a great article titled Fecal Transplants: They Work, The Regulations Don’t published in Wired Magazine, December of 2011. In it the author talks about a couple of early trial results on fecal transplants as well as some of the regulatory hurdles involved in getting serious studies launched. The success rates for this procedure so far are absolutely amazing, but it’s difficult for people to find doctors working in institutions that are broad minded enough to allow it.

I did find this video posted by Integris Digestive Health Center in Oklahoma City where they consider administering fecal transplants to those with recurring C. diff.

copyright 2010 Dia Osborn