Fecal Bacteriotherapy Human Stool Transplant Overview

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A fecal transplant, also known as fecal bacteriotherapy, is the process of restoring the bacteria commonly found in the digestive tract with an infusion of feces (stool) from a donor. While this sounds like a very strange concept, it is important to remember that our bodies require bacteria to digest food. Bacteria also helps maintain a normal movement of food and stool through the gut. When the bacteria in the digestive tract is destroyed, it can be very difficult to get back.

Normal Flora

The average person has hundreds of types of bacteria in the digestive tract. While it is possible to live without these bacteria, known as normal flora or digestive flora, they are extremely useful to the body.

These "good" bacteria help prevent overgrowth of bad bacteria, can enhance the immune system, and play a role in breaking down some types of undigested carbohydrates.

When we are born, we have bacteria in our system that we receive from our mother, as sort of a "starter culture." If the destruction of bacteria is severe enough, there may not be enough to grow back to normal levels without taking someone else's normal flora as a second starter culture.

Why Feces Are Transplanted

Feces are transplanted to replace bacteria that has been lost or destroyed by a disease or medical treatment. In a normal digestive system, hundreds of different types of bacteria are present. These bacteria, called normal flora, are necessary for effective digestion and play a role in preventing allergic reactions and enhance immune functions.

In a normal digestive system, the hundreds of different bacteria that make up normal flora work to keep a balance, keeping any one bacteria from overgrowing. The balance is a delicate one, and when medications interfere, overgrowth can occur. The result can be devastating to the digestive system. In most cases, the digestive system bounces back on its own, regrowing the normal flora. For some, however, the overgrowth results in repeated bouts of gastrointestinal distress and too little normal flora to be effective. For those, fecal bacteriotherapy is an important treatment option.

Feces can be transplanted as a treatment for severe clostridium difficile colitis, commonly known as "C. diff." C. diff typically results from a course of therapy with antibiotics that kill good bacteria in the process of killing bad bacteria. For severely ill patients, C. diff can lead to additional surgery or a longer recovery. For your average patient who contracts C. diff, there should be no need for a fecal bacteriotherapy, as this treatment is typically only used for those with recurrent C. diff. It is for those patients that qualify of life can be dramatically improved with a fecal transplant.

Squeamishness may be the primary reason more people do not have a fecal bacteriotherapy procedure. When faced with recurrent gastrointestinal problems, however, the concept of the accepting an infusion of donor feces becomes more tolerable for many patients. Many of the conditions that necessitate a fecal transplant cause severe, recurrent, and ongoing diarrhea.

At first, the idea of a fecal transplant may seem like a joke -- however, according to one study, fecal bacteriotherapy has a 91% success rate. For patients who experience repeated C. difficile overgrowth, and the extreme symptoms associated with it, the "grossness" factor may be a non-issue.

Fecal transplants are accepted as a treatment for multiple intestinal disease processes. However, when used to treat ulcerative colitis and inflammatory bowel disease, fecal transplants are considered an experimental therapy.

How Transplant Is Performed

The fecal sample is obtained from a donor within six hours of the transplant procedure. It is examined and tested for intestinal parasites and other signs of illness that might rule out the donor. If the sample is appropriate, it is prepared for transplantation, typically by mixing with sterile water and filtering through a coffee filter repeatedly to remove the solids.

This sample is then infused into the recipient in one of two ways, by enema or through a feeding tube.

If the enema method is used, the stool sample is placed into the enema bag or bottle, then infused into the rectum where it is held as long as possible. This is done repeatedly over the course of no less than 5 to 10 days, directly introducing the normal flora back into the intestinal tract.

The other method uses a feeding tube to infuse the stool sample directly into the intestine. This tube is typically used for feeding patients who are unable to tolerate typical types of food or tube feeding. It is inserted into the nose and down into the stomach, and it then continues to advance until it stops in the intestine. The fecal sample prepared for transplant is then infused through the tube, allowing it to be placed directly into the intestine.

In some cases, both the enema and the feeding tube methods may be used to reintroduce normal flora into the digestive tract.

Autologous Restoration of Gastrointestinal Flora (ARGF)

Autologous restoration of gastrointestinal flora, or ARGF, is a new technique that is currently being studied. In this process, patients who are at risk for destruction of the normal flora of the intestine provide a sample of their stool. The sample is stored, and if it is needed, it is filtered and freeze-dried. The sample is shaped into a capsule and coated, much like ibuprofen or other medications, so that it travels to the intestine prior to dissolving.

This technique, like the enema and feeding tube techniques, places the normal flora sample directly into the intestine where it can colonize.

Who Can Be a Feces Donor

Typically, a healthy partner or relative is considered the ideal candidate for fecal donation. There is no requirement that the donor be a relative; any willing person may volunteer to contribute. The medical history of the donor will be examined, along with their current state of health. The donor must be free of infectious diseases, such as hepatitis A, B and C, and HIV. They must also be free of parasitic diseases, yeast overgrowth, and other digestive tract issues that could potentially be given to the fecal recipient.

Prior to the donation, the donor may be asked to take an antibiotic regime to prepare for the donation.

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