Clostridium difficile (C. diff) infections are severe and cause terrible symptoms in patients. One effective, but strange treatment for the illness is a fecal microbiota transplant (FMT), in which donor stool is transferred into the C. diff patient; it restores balance to the community of gut microbes living in the gastrointestinal tract. A clinical trial has now shown that an FMT is effective in treating the infection, whether by swallowing capsules or by colonoscopy.
A pioneer of the treatment is Dr. Thomas Louie, a Clinical Professor at the Cumming School of Medicine. He is co-lead author of the study reporting these findings, published in The Journal of the American Medical Association. "Recurrent C. difficile infection is such a miserable experience and patients are so distraught that many ask for fecal transplantation because they've heard of its success," said Louie. "Many people might find the idea of fecal transplantation off-putting, but those with recurrent infection are thankful to have a treatment that works."
The authors expect their work to have a major impact on the field. "This will transform the way people think about how we deliver fecal microbiota transplant," noted the lead author, Dr. Dina Kao, an Associate Professor with the University of Alberta's Faculty of Medicine and Dentistry. "Capsules have numerous advantages over colonoscopy. They are non-invasive, they're less expensive, they don't have any of the risks associated with sedation and they can be administered in a doctor's office."
When patients took capsules of frozen donor bacteria, it treated the C. diff infection effectively 96 percent of the time; that is the same success rate as those receiving the FMT by colonoscopy. These pills aren’t as bad as they sound; they are processed until they only contain bacteria, and are encapsulated within several layers of gelatin. They don’t have a scent or taste. "The pills are a one-shot deal, not a continuing treatment," added Louie. "They are easier for patients and are well tolerated."
The microbial community within a healthy human gut contains hundreds of species, which help digestion and aid proper immune system function. If a person gets a bacterial infection and has to take antibiotics, they can suffer serious disruption to their gut bacteria. C. diff can take advantage of such a situation, and get a toehold.
C. diff infections cause gastrointestinal disruptions like diarrhea and cramping. In especially serious cases, the large intestine must be removed. C. diff is rare, but it can be debilitating and hard to get rid of; it resists antibiotics, and in some cases, it is fatal.
Canadian Karen Shandro of Ardrossan, near Edmonton, thought she was getting a sinus infection in early 2015. After taking antibiotics, a C. diff infection took hold, making her incredibly sick. More antibiotics were not helpful.
"I felt awful. My health deteriorated. I had unbearable diarrhea, no appetite, chills, and fever, and I couldn't keep any food in me," said Shandro. Her condition became so grave that she went to an emergency room. Shortly after, she learned about the FMT trial and was enrolled. Randomly, she ended up getting the transplant by capsule.
Shandro said that while the pills didn’t have a bad taste or aftertaste, the sheer number she had to consume was trying. Each participant took 40 capsules in only one hour. "Afterwards I went home and slept for four hours, then woke up starving, which was something new to me at that point," she said. Her health improved continuously, and within two days, she felt like her usual self. Her C. diff infection has been conquered. Hopefully, more patients will soon experience a similar outcome.