Fecal Transplant by Enema Works for Stubborn C. Difficile: Study

January 27, 2012

By Kerry Grens

NEW YORK (Reuters Health) Jan 26 - For patients with nearly no options to treat persistent Clostridium difficile infection, a transplant of someone else's fecal matter, delivered by enema, is helpful in nine out of 10 cases, according to a new study.

"It's unbelievably effective," said Dr. Neil Stollman, who was not involved in this research, but who has reported similar success using colonoscopy to deliver a stool transplant.

A few months ago, Reuters Health reported promising data on fecal transplants for inflammatory bowel disease, presented by a variety of groups at the American College of Gastroenterology's annual meeting. (See Reuters Health story of November 2, 2011.)

In the new study, led by Dr. Christine Lee at McMaster University in Hamilton, Ontario, researchers asked two healthy volunteers to donate fecal matter, which was diluted in water and used to treat 27 patients with refractory C. difficile infection.

Unlike earlier studies that have used a colonoscope or a nasogastric tube, Dr. Lee's group used an enema to deliver the feces.

"The rationale for using an enemy is it can be used in any setting and it's not an invasive procedure," she told Reuters Health.

All but two patients recovered after the procedure, and the vast majority felt better within one day, Dr. Lee and her colleagues reported Monday in Archives of Internal Medicine.

"I would recommend it to anyone who has had recurrent C. difficile infection," Dr. Lee told Reuters Health.

Dr. Stollman, who practices at Northern California Gastroenterology Consultants, said only about 10% of patients are good candidates for the stool transplant, but that number is on the rise.

"C. diff is exploding," Dr. Stollman said.

Dr. Lee's team notes that the rate of C. difficile infections tripled between 1996 and 2005, and they now affect about 84 out of every 100,000 people.

Dr. Stollman said that so far he has seen no drawbacks to the procedure, but given that most studies are only several years old, it's unclear whether long term side effects could emerge in the future.

How, exactly, the transplanted material helps is unknown. Dr. Lee said it could be that the newly introduced bacteria outcompete the C. difficile organisms, or it could be that bacterial by-products in the stool help restore balance to the gut.

"The whole underpinning of this procedure is, if I don't know which bacteria to put in and in what concentration, let's put it all in," said Dr. Stollman. "It's an inelegant procedure with an elegant outcome."

SOURCE: http://bit.ly/xtXkDN

Arch Intern Med 2012.