Fecal Transplant

I heard about fecal transplant at a GI conference I attended recently. It was a new one for me! If I remember correctly, it can be used for C-diff that is not responding to other treatment -- kind of a last resort. The idea is that in severe C-diff, all the patient's "good" bacteria have been overwhelmed by the C-diff and are very depleted. Stool is collected from a family member (who would tend to have similar bacteria as normal colon residents) and is administered by NG tube (not PO!). The influx of "good" bacteria will then, hopefully, overwhelm the C-diff.

I first heard about fecal transplant on a podcast about an MD who had C-diff and his "friends" offering their "flora" for a transplant. I wondered if they were joking and did some research and found out it was legit. I was talking about it at work the next day and my co-workers weren't buying the story - until one of the doctors who'd be overhearing piped in. She said they were about to give up on a patient of hers who was so fragile and deteriorating so rapidly from multiple problems and a prolonged battle with c-diff. She ordered the transplant and his turn around was rapid. They can use an NG but she said the patients route of first choice is almost always going to be by enema - which is fine. She said it wasn't as gross as what she had envisioned. The "broth" came from the lab and wasn't like just putting a fresh BM from one person into another. It makes sense when you think about it,... but I try not to think about it.

The thought about it is bad enough, Eyoo, by NG TUBE!!!!

It was done last week for the first time in our clinic by one of the GI Dr.s. The "donor" was the patient's daughter and the stool was "administered" during the colonoscopy.Apparently it was succesful!

I work on a GI/detox unit and we had a patient who had chronic c. diff. The last resort was to attempt a stool transplant as the pt was no longer responding to antibiotics. The patient's friend was the one to donate the stool. When we received the donated stool, it was to be strained, and put in an enema bag. In this case, it was administered through enemas, as opposed to NG. The patient had 4 treatments in total, and was soon discharged as he was asymptomatic within 24 hours of the last treatment. The GI doc who was following this patient let us know last week that the patient remains asymptomatic at home (~4 months).

The lady who lives across the street from my parents had it done...she used to be in the hospital two or three times a month because the c-diff was so bad...she would go days at a time without even being able to eat. She actually has problems with constipation now...

Why don't they try probiotics?

I know an acupuncturist who suggested alternating implants of garlic and probio's for a pt. who came to him (as a last resort) w/ a mysterious GI problem presenting w/ violent diarhhea. The treatment worked. The antibiotic qualities of the garlic killed off the intestinal bugs, and the probio's repopulated the gut. When the acupuncturist tried to call the pt's Dr. to tell him about the success, the Dr. got ****** and hung up on him b/c the Dr. was about to publish an academic paper on the pt's difficult condition.

There's got to be a better way than using other people's fecal matter. ICK.

Probiotics such as lactobacillis *are* being used regularly both for the prevention and part of the treatment for C.diff. colitis (Haven't heard of garlic) The fecal transplants are only being used as a last resort when all the big gun therapies (Vanc +Flagyl, etc.) have been ineffective in severe cases.
"Fecal Bacteriotherapy" is another term for it. (Which I think sounds better. )

We have done a fecal transplant with great success. However our hospital has subsequently asked that we never do this in the future. As we have no protocal for the procedure. Does anyone know of protocals or best practice articles that I could present to our administration?