Hold your nose and don't spit out your coffee: Doctors have found a way to put healthy people's poop into pills that can cure serious gut infections — a less yucky way to do fecal transplants.
Canadian researchers tried this on 27 patients and cured them all after strong antibiotics had failed to help.
It's a gross topic but a serious problem. A half-million Americans get Clostridium difficile infections each year, and about 14,000 die. The C. diff germ causes nausea, cramping and diarrhea so bad it is often disabling.
A very potent and pricey antibiotic can kill C. diff but also destroys good bacteria that live in the gut, leaving it more susceptible to future infections.
Recently, studies have shown that fecal transplants — giving infected people stool from a healthy donor — can restore that balance. But they're given through expensive, invasive procedures such as colonoscopies or throat tubes. Doctors also have tried giving the stool through enemas, but the treatment doesn't always take hold.
Dr. Thomas Louie, an infectious disease specialist at the University of Calgary, devised a better way: a one-time treatment made for each patient.
Donor stool, usually from a relative, is processed in the lab to take out food and extract the bacteria and clean it. It is packed into triple-coated gel capsules so they won't dissolve until they reach the intestines.
“There's no stool left — just stool bugs. These people are not eating poop,” Louie said. He also said there are no smelly burps because the contents aren't released until they're well past the stomach.
Days before starting the treatment, a patient is given an antibiotic to kill the C. diff. On the morning of the treatment the patient has an enema so “the new bacteria coming in have a clean slate,” Louie said.
It takes 24 to 34 capsules to fit the bacteria needed for a treatment, and patients down them in one sitting. The pills make their way to the colon and seed it with the normal variety of bacteria.
Louie described 27 patients treated this way on Thursday at IDWeek, an infectious diseases conference in San Francisco. All had suffered at least four C. diff infections and relapses, but none has had a recurrence after taking the poop pills.
Dr. Curtis Donskey of the Cleveland Veterans Affairs Medical Center, who has done fecal transplants through colonoscopies, praised the work.
Other researchers are trying to find which bacteria most help fight off C. diff. Those might be grown in a lab dish and given to patients rather than the whole spectrum of bacteria in stool.
The hope is “we could administer that as a probiotic in a pill form,” Donskey said.
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