Fecal bacteriotherapy 3762041 215515228 2008-05-28T15:20:40Z DOI bot 6652755 Citation maintenance. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]]. [[Image:E coli at 10000x, original.jpg|thumb|right|250px|[[E Coli|Fecal bacteria]] at 10,000× magnification]] '''Fecal bacteriotherapy''', also known as '''fecal transfusion''', '''fecal transplant''', or '''human probiotic infusion''' (HPI), is a medical treatment for patients with [[pseudomembranous colitis]] (caused by [[Clostridium difficile]]), [[ulcerative colitis]] and [[irritable bowel syndrome]] which involves restoration of colon [[homeostasis]] by reintroducing normal bacterial flora from stool obtained from a healthy donor. ==Description of procedure== The procedure itself involves a 5 to 10 day treatment with [[enema]]s, made of bacterial flora from feces of a healthy donor (who needs to be tested for a wide array of bacterial and parasitic agents). The enemas are prepared and administered in a hospital environment to ensure all necessary precautions. The probiotic infusion can also be administered through a nasogastral tube, delivering the bacteria directly to the small intestine.<ref name="pmid12594638">{{cite journal |author=Aas J, Gessert CE, Bakken JS |title=Recurrent Clostridium difficile colitis: case series involving 18 patients treated with donor stool administered via a nasogastric tube |journal=Clin. Infect. Dis. |volume=36 |issue=5 |pages=580–5 |year=2003 |pmid=12594638 |doi= |url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID21158}}</ref> The two methods can be combined to achieve the best result. Regular checkups are required up to a year following the procedure. ==Theoretical basis== The hypothesis behind fecal bacteriotherapy rests on the concept of bacterial interference - using harmless bacteria to displace [[Pathogen|pathogenic]] organisms. This approach to combating bacterial infections is not new<ref>{{cite journal | author = Sanders WE, Sanders C | title = Modification of normal flora by antibiotics: effects on individuals and the environment. | journal = New Dimensions in Antimicrobial Chemotherapy. | pages = 217–241 | year = 1984}}</ref>, and has long been used in animals - for example, to prevent salmonellosis in chickens<ref>{{cite journal | author = Nurmi E, Rantala M | title = New aspects of Salmonella infection in broiler production.| journal = Nature| volume = 241 | issue = 5386| pages = 210–211| year = 1973| id = | doi = 10.1038/241210a0 }}</ref>. In the case of [[pseudomembranous colitis]] the pathogen is known (''[[clostridium difficile|C. difficile]]''), but since no single pathogen causing ulcerative colitis has been found so far, the effectiveness of fecal bacteriotherapy suggests that the cause of ulcerative colitis may be a previous infection by a still unknown pathogen. It is possible that this initial infection resolves itself naturally, but somehow causes an imbalance in the colonic [[Gut flora|bacterial flora]], leading to a cycle of inflammation (explaining the remitting-relapsing nature of the disease) which can be broken by recolonizing the colon with bacteria from a healthy bowel<ref>{{cite journal | author = Borody T, Warren E, Leis S, Surace R, Ashman O, Siarakas S | title = Bacteriotherapy using fecal flora: toying with human motions. | journal = J Clin Gastroenterol | volume = 38 | issue = 6 | pages = 475–83 | year = 2004 | pmid = 15220681 | doi = 10.1097/01.mcg.0000128988.13808.dc}} [http://www.cdd.com.au/pdf/toyingmotions.pdf PDF]</ref>. This may be considered an extension of [[probiotic]] research. ==Effectiveness== The procedure has been used to successfully cure ''[[clostridium difficile|C. difficile]]'' infections for a number of years, with a success rate of nearly 95% according to some sources<ref>{{cite journal | author = Schwan A, Sjölin S, Trottestam U, Aronsson B | title = Relapsing clostridium difficile enterocolitis cured by rectal infusion of homologous faeces. | journal = Lancet | volume = 2 | issue = 8354 | pages = 845 | year = 1983 | pmid = 6137662}}</ref><ref>{{cite journal | author = Paterson D, Iredell J, Whitby M | title = Putting back the bugs: bacterial treatment relieves chronic diarrhoea. | journal = Med J Aust | volume = 160 | issue = 4 | pages = 232–3 | year = 1994 | pmid = 8309401}}</ref><ref>{{cite journal | author = Borody T | title = "Flora Power"-- fecal bacteria cure chronic C. difficile diarrhea. | journal = Am J Gastroenterol | volume = 95 | issue = 11 | pages = 3028–9 | year = 2000 | pmid = 11095314}} [http://www.cdd.com.au/pdf/paper32.pdf PDF]</ref>. The benefits of fecal bacteriotherapy include reducing the risk of antibiotic-associated resistance, cost savings when compared to repeated courses of antibiotic therapy, and high success rate. It is still considered a "last resort" therapy due to the inherent risks involved, and lack of [[Medicare (United States)|Medicare]] coverage for donor stool screening and instillation procedure.[http://www.idsociety.org/newsArticle.aspx?id=8160] While its effects on ulcerative colitis have not yet been adequately researched, small case series suggest it has positive effects. A recent article by Borody et al which details 6 cases of severe chronic [[ulcerative colitis]] treated using Fecal bacteriotherapy suggests that the procedure may be extremely successful in these cases as well. Complete reversal of symptoms was achieved in all patients by 4 months post-HPI, by which time all other UC medications had been ceased. At 1 to 13 years post-HPI and without any UC medication, there was no clinical, colonoscopic, or histologic evidence of UC in any patient<ref>{{cite journal | author = Borody T, Warren E, Leis S, Surace R, Ashman O | title = Treatment of ulcerative colitis using fecal bacteriotherapy. | journal = J Clin Gastroenterol | volume = 37 | issue = 1 | pages = 42–7 | year = 2003 | pmid = 12811208 | doi = 10.1097/00004836-200307000-00012}} [http://www.cdd.com.au/pdf/UC%20bacteriotherapy.pdf PDF]</ref>. The Sydney group also reports a case of presumed [[Primary sclerosing cholangitis|sclerosing cholangitis]], a disease frequently associated with [[Inflammatory bowel disease|IBD]], which recovered fully after the treatment. ==History== It has been developed in recent years by Dr. [[Thomas Borody|Thomas J. Borody]] and his team in Sydney, Australia, primarily as an alternative treatment for [[pseudomembranous colitis]]. This disease is caused by ''[[clostridium difficile|C. difficile]]'' infection, and is typically treated with [[antibiotics]]. == See also == *[[Pseudomembranous colitis]] *[[Ulcerative colitis]] *[[Irritable bowel syndrome]] *[[Inflammatory bowel disease]] *[[Helminthic therapy]] == External links == *[http://www.cdd.com.au/ Center for Digestive Diseases, Sydney, Australia] *[http://www.probiotictherapy.com.au/ Probiotic Therapy Research Centre, Sydney, Australia] *[http://groups.google.com/group/hpit Google group for patients interested in fecal bacteriotherapy] *[http://scienceblogs.com/aetiology/2007/12/fecal_transplants_to_cure_clos.php Fecal transplants to cure Clostridium difficile infection] *[http://www.cbc.ca/health/story/2007/11/13/fecal-transplant.html?poop=2 Don't poo-poo technique: Fecal transplant can cure superbug, doctors say] *[http://www.cbc.ca/MRL/clips/rm-hi/taylor-fecal-071115.rm Canadian Broadcasting Corporation News video report on fecal bacteriotherapy for ''Clostridium difficile''-caused diarrhea] ==References== {{reflist|2}} {{Gastroenterology}} {{Operations and other procedures on the digestive system}} [[Category:Experimental medical treatments]]