October 3, 2013
News Review From Harvard Medical School -- 'Poop Pills' Used to Cure Colon Infections
For several years, doctors have been curing dangerous colon infections by transplanting feces containing normal, healthy bacteria into the diseased colon. Now there's an easier way to deliver the dose: poop pills. Actually, feces from a donor are processed so there's nothing left but the bacteria. Placed in pills and then swallowed, the healthy bacteria replace the cause of infection: Clostridium difficile (C. diff). These infections often occur in people who take antibiotics for another reason. The drugs also kill healthy bacteria in the gut. But C. diff lives in hardy spores that can become active when other bacteria disappear. C. diff causes dangerous inflammation and diarrhea. Doctors have used transplants of feces to cure C. diff infections that keep coming back. The transplants were put into the colon through the nose or rectum. Researchers described their new pill method at a conference. Patients were given antibiotics to kill C. diff and enemas to clean out the colon. Then they swallowed 24 to 34 pills containing the bacteria from feces. The transplant restored their healthy colon bacteria. Researchers said all 27 patients were cured. HealthDay News wrote about the new treatment October 3.
By Mary Pickett, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Read this only if you have a strong stomach. Sometimes even good news is hard to swallow.
A triumph in pill packaging is allowing patients with a stubborn kind of colon infection to have a gross but potentially life-saving treatment. Patients can now swallow feces from a friend or family member in a pill.
You can laugh, but this is big news in the medical community. We are all talking about it. ("I dare you to tell your kids about this one at dinner," one of my doctor-colleagues said to me yesterday.) This kind of treatment is called fecal transplant.
Fecal transplant aims to fix a problem that is caused by antibiotics. These drugs kill the many types of bacteria that normally live on our skin, in our intestines and on other body surfaces. They are called our "normal flora."
But antibiotics do not kill spores. Spores are a hardy, dormant form of bacteria. Spores from a bacterium named Clostridium difficile (C. diff) are commonly carried in the human gut. When your normal flora are varied and healthy, C. diff stays in its spore form. But changed chemistry in the gut can allow C. diff to convert into more active bacteria. Active C. diff makes a toxin that can cause diarrhea and life-threatening inflammation of the colon.
It is hard to get rid of C. diff. You need to take specific antibiotics that kill the active bacteria. But spores can remain. If you don't recover a good mix of gut bacteria, spores may again blossom into a full-fledged C. diff infection. This sort of relapse happens to 10% to 25% of people who have C. diff infections.
This is where fecal transplant can help. If normal flora can be quickly restored to the colon, C. diff spores will not activate. Results of fecal transplant are genuinely impressive. In studies, transplants have cured 85% to 93% of relapsing C. diff infections.
Up to now, fecal transplant has not been pretty. Fresh stool from a healthy donor has essentially been put into a blender and mixed with saline or milk until it is a thin liquid.
After this step, doctors have used one of three ways to get this sample into a patient. It can be pumped into a tube through the nose over several days. Or it can be given in the form of an enema (a liquid injected into the rectum). An enema is given for five days in a row. Each time, the patient tries to hold on to it for six uncomfortable hours before using the bathroom.
The third option is to have it delivered by colonoscopy. This option involves a tube inserted into the colon through the rectum. It has had the best results so far. But most doctors don't offer it.
Today's good news is a pill-packing technology that allows individual ("fresh") stool samples from your personal donor to be purified and "triple-wrapped" in a plastic capsule. This means you can swallow a clean, odorless pill. It does not lose its protective gel cover until it is safely deep in your digestive tract. The only drawback is that in order to get a full dose, you will need to swallow 24 to 34 capsules in one day.
What Changes Can I Make Now?
The best way to deal with C. diff infection is to avoid it altogether.
You are more likely to carry spores in your gut if you take antacid medicine on a regular basis. Acid protects us against spores. This is a good reason to take antacids for only a short time, unless your doctor advises you to continue them.
Take antibiotics only when you need them. Antibiotics are used too often, particularly for upper respiratory symptoms that have lasted less than a week. Viruses cause about 90% of respiratory and cold symptoms, such as runny nose and mild sore throat. Viruses do not respond to antibiotics.
Some people who do need antibiotics consider taking a "probiotic" afterward. Probiotics are yogurt or pills containing bacteria. Unlike a complete fecal transplant, mass-produced probiotics have not been able to recreate the mature bacterial mix of the human colon.
Several small studies have hinted at a bit of benefit from available probiotics. But results from a larger, well designed study published last year showed no benefit.
What Can I Expect Looking to the Future?
For a while, the pill form of fecal transplant will be available only for our worst C. diff cases. Because the stool sample needs to be fresh, it can't be mass-produced. But work is under way to expand production. For example, flash-freezing of stool capsules might be feasible.
In the future, stool capsules might even be used to prevent infection with C. diff in people who have received antibiotics. With such a broad application in its future, this isn't a technology to be "poo-poo'ed."