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01-28-2011, 11:49 AM   #1
Cat-a-Tonic
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Fecal Transplants

I saw this article and just had to share.

http://www.slate.com/id/2282768/pagenum/all/#p2

The Enema of Your Enemy is Your Friend
Fecal transplants could be a cheap and effective treatment for gastrointestinal disorders.
By Emily P. Walker
Posted Thursday, Jan. 27, 2011, at 4:26 PM ET

One day in 2008, Ruth, a Long Island teacher, walked into her doctor's office with a container of a relative's feces, lay down, and had her doctor pump the stool inside her. Ruth had been suffering for nearly two years with an intestinal infection called Clostridium difficile, which caused her to suffer from excruciating diarrhea. She had lost 20 pounds. Her hair was falling out. Friends asked if she had cancer.

Then she met Lawrence Brandt, a gastroenterologist in the Bronx who believed he had developed a procedure to cure people of recurrent c. diff infections: fecal transplant. Brandt has been inserting feces into his patients for a decade now and claims to be solving their problems nearly 100 percent of the time. If his method really works—and he's not the only doctor who believes that it does—then we may have found a viable, if weird, solution to a serious problem. C. diff infects 250,000 Americans each year and killed more than 20,000 from 1999 to 2004. (Researchers estimate that 13 out of every 1,000 patients admitted to a hospital will pick up the bug.) Antibiotics will always be the first response to such infections, but when those fail, a fecal transplant could be the next step. For Ruth, at least, the procedure was a godsend. "I'm cured," she said. "Period. End of story. Cured."

Here's the basic idea. People suffering from the hardy C. diff bacteria are generally prescribed a powerful antibiotic. Problem is, the drugs don't just kill the invaders; they also wipe out much of the beneficial bacteria in the gut. With these "good" microorganisms out of the way, any C. diff stragglers have a much easier time regrouping for a second bout of illness. If there were some way to respawn the beneficial bacteria in the intestines, such re-infections could be warded off. Some people, like Ruth, turn to expensive probiotic supplements. (At one point she was spending $350 on them every week.) But in certain cases, a patient who has lost nearly all of her good bacteria will find it nearly impossible to get them back. A fecal transplant seems to work as a sort of mega-probiotic, allowing doctors to repopulate a patient's intestines with the appropriate microorganisms by placing a robust sample directly into her gut.

Doctors recommend that the fecal donor be someone close to the patient—a family member, perhaps, or a spouse. Scientists reason that when people live in close quarters, they are exposed to similar bacteria—good and bad—and are likely to have had a similar set of bacteria living in their guts before anyone got sick.

The donor takes a stool softener the night before and then gives a full morning bowel movement to the recipient, who takes it to a doctor for screening. It's important to make sure that the sample doesn't contain any parasites or other pathogens, such as hepatitis, salmonella, or HIV. Once the transplant material has been cleared, the doctor mixes it with saline to make about a pint of liquid with the consistency of a milkshake. This is pumped into the patient's colon using a colonoscope or endoscope, or siphoned into the stomach via a nasogastric tube. (The latter method is considered more dangerous, since there's a chance feces will end up in the lungs. Colonoscopies carry their own risk of bowel perforation.)

And then there's the do-it-yourself crowd. All you need is a bottle of saline, a 2-quart enema bag, and one standard kitchen blender. Mike Silverman, a University of Toronto physician who wrote up a guide to homespun fecal transplants for the journal Clinical Gastroenterology and Hepatology, says it's entirely safe to do the procedure this way, provided that a doctor gets involved at some point to screen the donor sample. He felt he needed to draw up the instructions because administrators at his hospital wouldn't allow their doctors to perform a procedure that hasn't been validated in a large, peer-reviewed study.

It's true there's been no major clinical trial of fecal transplants, but the procedure appears in the medical literature at least as far back as 1958. That's when a Denver-based surgeon named Ben Eiseman performed four of the procedures to rid patients of a form of colitis thought to be caused by C. diff. His plan was to administer "normal feces into the colon of patients with the disease," so as to "re-establish the balance of nature." Three of his four patients were near death before the fecal enema. After, they recovered. This small experiment suggested a "simple yet rational therapeutic method," Eiseman and his colleagues wrote, that deserved careful evaluation.

Now we're beginning to see some more extensive studies. Mark Mellow, a gastroenterologist at INTEGRIS Health in Oklahoma City, recently presented a paper showing that 15 out of 16 C. diff patients whom he'd provided with a fecal transplant remained disease-free after five months. Several other papers presented at the meeting showed similar positive effects, and in every case, symptoms disappeared almost immediately after the transplant.

Still, the evidence supporting fecal transplant comprises just about 20 published case reports involving about 200 patients. Until a large-scale, randomized trial is published in a big-name medical journal, most doctors will likely follow the example of the University of Toronto and hold off on performing the transplant. Indeed, relatively few gastroenterologists have even tried it. Colleen Kelly, a gastroenterologist at Women & Infants Hospital of Rhode Island, surveyed 72 gastroenterologists at a recent international medical meeting and found that only seven had performed the procedure. Nearly half said they'd be willing to perform a transplant on a sick patient, but the rest said they weren't ready yet. "I really think in another couple of years, it's going to be something that everyone's doing," said Kelly, who has performed the operation 22 times herself.

Infectious-disease experts are a little more tempered in their enthusiasm. According to Vincent Young of the University of Michigan, the data look promising but he wouldn't perform a fecal transplant himself because there are too many unknowns about what bad things might be lurking in a stool sample. William Schaffner, president of the National Foundation for Infectious Diseases, warned that the procedure is still in its early days and not yet ready for prime time. (The American College of Gastroenterology, for its part, has no official position on fecal transplants.)

But the true believers have even bigger plans. They hope fecal transplants might be used to treat other gut-related conditions, such as ulcerative colitis and even obesity. Some very overweight people, for example, are thought to have more of a certain type of bacteria in their intestines, which causes them extract extra calories from complex carbohydrates. With this in mind, researchers found that fat mice would lose weight if transplanted with feces from thin ones. Later, a team of Dutch researchers tried the same approach in humans: No one lost weight, but the fecal recipients did show a significant improvement in their ability to regulate insulin. (That study is under review and should be published in the next few months.)

For all its promise, it's unlikely fecal transplants will take off any time soon. Not because patients are grossed out by the procedure—in fact, doctors say that long-standing sufferers from C. diff are eager to have it done—but because there's so little funding for large-scale clinical trials. Drug or medical-device companies usually foot the bill for such research, but in the case of a natural, patent-free treatment like this, no company stands to turn a major profit. If anything, fecal transplants would end up costing the pharmaceutical companies money: A single pill of vancomycin—one of two antibiotics used to treat C. diff—costs about $55, and the average dose is four pills daily over a two-week stretch. A glass of shit, on the other hand, costs very little. That doesn't mean we'll never get the much-needed data: Lawrence Brandt, the gastroenterologist in the Bronx, is applying for a grant with the National Institutes of Health for a small, double-blind, controlled study. He says he'll need about 40 patients, and he's hoping to get started right away.
What do you guys think? Would you ever try this? Has anyone here tried it, and if so, what were the results?
01-28-2011, 12:11 PM   #2
glum chump
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Hi Cat:

I am so desperate at this point to try to shift my Crohn's from severe to at least mild, that I would consider anything. I've been reading about fecal transplants for a while now and would most definitely consider it as an option. When I spoke to my GI about it over a year ago, he said that the science behind it was not secure enough for many GIs to be using it as a viable option. I know of a doctor in Calgary (which is about a two hour plane ride from where I live) who had been doing it and was trying to get in touch with him, but never heard back.

Recently, doctors from a local health authority near where I live were trying to push the health authority into allowing fecal transplants for those with CDiff who were not responding to antibiotic treatment. I am hopeful that these doctor's might be the ones who push other GIs into taking fecal transplants more seriously and consider doing it as a treatment option for patients with Crohn's.

At this point, I ain't got much to lose! My brother has already extolled the virtues of his BMs and seems to consider himself an ideal donor...based on our childhood and the amount of pleasurable time he spent in the bathroom, I don't doubt it!

Thanks for the article.
01-28-2011, 05:20 PM   #3
David in Seattle
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I saw this article and just had to share.

http://www.slate.com/id/2282768/pagenum/all/#p2



What do you guys think? Would you ever try this? Has anyone here tried it, and if so, what were the results?
I've read a number of articles on this & I think it's an excellent idea. I believe it was 1st tried in the late 1950's for C. Difficile. I've also thought of the "DIY" approach, and I would be very willing to give that a try, if I had a good source of material.

The main factor limiting the technique is that, unlike expensive antibiotics, there is no well-heeled business interest which stands to profit, so study $$$ and promotion have been low. Plus, I'm sure many would find it distasteful, though that's silly, IMO. Again, I think it's a terrific, completely natural approach which, assuming clean feces are used (containing no harmful microorganisms, only beneficial ones), would be low cost and have virtually no down side.
01-28-2011, 07:26 PM   #4
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I would do it in a heartbeat if I thought I had the option. Even if it didn't work, the negative consequences of many of our other options don't seem to be as much of a concern. By this I mean there's no readily apparent down side.
01-28-2011, 08:03 PM   #5
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i have an appointment with my gastro feb 1 im seriously thinking about asking if he does it
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01-29-2011, 12:50 PM   #6
ameslouise
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OMG. Am I the only one who thinks this is absolutely disgusting? I am nauseous right now even thinking about putting someone else's shit into my body. I would try a lot of alternative treatments, but I'm just don't know about this one.

I guess if someone said, "This will 100% put you into remission with zero side effects" I would be right there putting a ziploc bag under my husband's ass. But damn, it's still really gross. And I don't get grossed out easily at all!

- Amy
02-04-2011, 12:29 PM   #7
tiloah
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http://www.slate.com/id/2282768/

My favorite part of the article:
And then there's the do-it-yourself crowd. All you need is a bottle of saline, a 2-quart enema bag, and one standard kitchen blender. Mike Silverman, a University of Toronto physician who wrote up a guide to homespun fecal transplants for the journal Clinical Gastroenterology and Hepatology, says it's entirely safe to do the procedure this way, provided that a doctor gets involved at some point to screen the donor sample..
02-04-2011, 12:39 PM   #8
Ian
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I guess if someone said, "This will 100% put you into remission with zero side effects" I would be right there putting a ziploc bag under my husband's ass.

- Amy
LOL!

That is all
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02-13-2011, 08:34 PM   #9
partlycloudy
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My brother has already extolled the virtues of his BMs and seems to consider himself an ideal donor...based on our childhood and the amount of pleasurable time he spent in the bathroom, I don't doubt it!
LOL, I busted out laughing at this.

I'll tell ya one thing, it'd be a great story to gross your kids and family out with if you ever have the procedure done!
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02-13-2011, 10:49 PM   #10
Eppie
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\ shaking head about this one....I think it is worse than the intestinal worm treatment I heard about 10 years ago (google cd and heliminths). Or save your vom gag reflex and don't look it up. poo enemas sound too bizarre to be real.
Eppie
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02-14-2011, 09:50 AM   #11
Piatchi
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A standard kitchen blender.

Uh huh. I make shakes with that thing
04-07-2011, 08:47 PM   #12
aliciars
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A standard kitchen blender.

Uh huh. I make shakes with that thing
Definitely be getting a new blender after that! Ewwwwww.
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04-07-2011, 08:58 PM   #13
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Wow! That is really bizarre!!!
04-07-2011, 09:20 PM   #14
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OMG. Am I the only one who thinks this is absolutely disgusting? I am nauseous right now even thinking about putting someone else's shit into my body. I would try a lot of alternative treatments, but I'm just don't know about this one.

I guess if someone said, "This will 100% put you into remission with zero side effects" I would be right there putting a ziploc bag under my husband's ass. But damn, it's still really gross. And I don't get grossed out easily at all!

- Amy
My thoughts exactly!
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04-08-2011, 02:21 AM   #15
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Lol! i wish I hadnt read this thread now - it's put me right off my breakfast. I don't think I could fact this without being knocked out for at least a week. But my symptoms are not as severe as many here and if it's going to work I can see why people would go for it. A very natural solution in a very unnatural sort of a way.
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04-08-2011, 11:56 AM   #16
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Now I've heard it all! The things we will do to get rid of this condition, just shows you how bad it really is! S
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04-08-2011, 12:47 PM   #17
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Oh Dear God!
I'm sorry, but this is just so wrong!
What next? Drinking someone's vomit?
Puuurrrleeese!
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04-09-2011, 06:27 AM   #18
Piatchi
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I've read that this can be done during a scope. You would be out.

Come on folks, this forum talks about poop a lot to be grossed out by this procedure.
And what's worse? Somebody's recycled dinner from yesterday, or C. Difficile?

Bob's recycled dinner, please.
04-09-2011, 09:48 AM   #19
Jer's Girl
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I would so do this if it would work!
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04-09-2011, 03:04 PM   #20
ameslouise
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Too late for me! "Road Closed!"
04-09-2011, 07:56 PM   #21
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When I was at the doctor the last time and a few of us were in a room getting our iron infusions this lady I saw there before started talking. She said that she had an ostomy for a while and they were discussing with her getting the reversal of which she wants. The doctor told her since it has been so long that getting the good bacteria back in her intestines is necessary and the above mentioned would be a good therapy for her.

She made me laugh when she was describing the conversation with her doctor and her husband and herself in the room.....

The doctor told her that she would need someones fecal matter who lived in the house with her....she looked at her husband she said and his response was:

What I thought you said this morning you were not going to take any more of my Sh*t!!!
She had a lot of us laughing!! She did say she is willing to try anything to get that reversal and make it successful even if it meant having this done.
04-09-2011, 08:51 PM   #22
hawkeye
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Apparently there is a hospital in Toronto gearing up for a "randomized control trial" of the transplants in fighting c-diff according to this article -

http://www.healthzone.ca/health/news...a-read-on?bn=1


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04-09-2011, 09:26 PM   #23
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I'm pondering how this would work for crohn's. Since crohn's is your immune system fighting the good micro-organisms in your body wouldn't it do the same thing once the organisms from the donor's body are introduced, or does your immune system not have enough time to react to the micro-organisms before they've already done their beneficial work. Or do the white blood cells from the donor's fecal matter also play a beneficial part for crohn's patient. I guess these questions are why the trials are needed.

I'm sorry but it just doesn't seem very logical for use in crohn's patients. Although an invisible matter (dark matter) that holds the galaxies together is not very logical either, but scientists know for a fact that it does exist in some way or form.
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Last edited by scifi-enthusiast; 04-10-2011 at 12:23 AM.
04-15-2011, 12:32 AM   #24
troydanielbecker
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It looks to be for UC but not Crohn's. And clinically most effective in treating c-diff (in the published research).

I guess I've gotten quite intimate with fecal matter over the past year--it doesn't seem bad to me. Let the good poo teach the bad poo some manners.

The challenge, though, is not in the saying, but in the doing. I hope to keep you posted on this one.

From the 2003 Borody Abstract:

Treatment of ulcerative colitis using fecal bacteriotherapy.
Borody TJ, Warren EF, Leis S, Surace R, Ashman O.

Centre for Digestive Diseases, 144 Great North Rd, Five Dock NSW 2046, Australia. [email protected]
Abstract
BACKGROUND: Although the etiology of idiopathic ulcerative colitis (UC) remains poorly understood, the intestinal flora is suspected to play an important role. Specific, consistent abnormalities in flora composition peculiar to UC have not yet been described, however Clostridium difficile colitis has been cured by the infusion of human fecal flora into the colon. This approach may also be applicable to the treatment of UC on the basis of restoration of flora imbalances.

GOAL: To observe the clinical, colonoscopic and histologic effects of human probiotic infusions (HPI) in 6 selected patients with UC.

CASE REPORTS: Six patients (3 men and 3 women aged 25-53 years) with UC for less than 5 years were treated with HPI. All patients had suffered severe, recurrent symptoms and UC had been confirmed on colonoscopy and histology. Fecal flora donors were healthy adults who were extensively screened for parasites and bacterial pathogens. Patients were prepared with antibiotics and oral polyethylene glycol lavage. Fecal suspensions were administered as retention enemas within 10 minutes of preparation and the process repeated daily for 5 days. By 1 week post-HPI some symptoms of UC had improved. 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.

CONCLUSIONS: Colonic infusion of donor human intestinal flora can reverse UC in selected patients. These anecdotal results support the concept of abnormal bowel flora or even a specific, albeit unidentified, bacterial pathogen causing UC.
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04-21-2011, 12:05 PM   #25
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I am with Amy on this one. Yuck.
04-22-2011, 07:14 PM   #26
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All I have to say is "YUCK!"
04-22-2011, 09:55 PM   #27
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I don't know, if I was suffering from C. Diff on top of the Crohn's, I think I might do it. I have read several articles on this and in a gross way it really makes sense.
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04-22-2011, 11:54 PM   #28
David
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As far as I'm concerned, if they find a clinically proven way to reduce my pain without potential for serious side effects, they can shove whatever they want up there. Fecal matter, apple pie, small robots, cheese whiz, explosive devices; I don't care, I'm game. I've already had strangers' fingers, thumbs and a garden hose with a camera attached to it up there, so duct tape open my cheeks and let's go for it. I'll bring the tape and vanilla ice cream if it's pie.
04-23-2011, 10:58 AM   #29
Cat-a-Tonic
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David, too funny! Now all I can picture is a tiny robot carrying pie and cheese whiz. I'm totally with you, if that would make me feel better, I'm all for it. I've pretty much already had a robot go through me anyway, if you consider that the pill cam is kind of like a tiny robot.
04-23-2011, 01:06 PM   #30
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Ha! Y'all always make me laugh! Yeah, bring on the cheese whiz!
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