Fecal Biotherapy and UC
Ted recently wrote into the blog querying the use of fecal biotherapy in UC and a common bacterial gastrointestinal infection known as Clostridium difficle (C. diff).Fecal biotherapy refers to the process of taking stool from a healthy donor and administering it to another individual either by colonoscopy, enema, or a tube inserted from the nose into the intestine. The concept behind this is that the gut theoretically becomes colonized with the bacteria from the healthy donor's stool in the hopes of healing a gastrointestinal malady. This is an extension of probiotic therapy discussed in prior blogs.
There have been at least 3 or 4 published studies regarding the use of fecal biotherapy in UC showing some degree of benefit. In these studies, patients with severe UC or UC losing response to other therapies were given retention enemas of stool from donors. On average, the enemas were administered daily for approximately 5 days. The authors of these studies have suggested that many patients had improved symptoms or achieved remission of UC for 6 months to 13 years. A few caveats to this research are that: 1) the numbers of patients studied were small, 2) none were randomized control trials (the "gold standard" study design for assessing efficacy of treatment), and 3) they are possibly limited by publication bias (ie; studies that show a positive treatment result get published and those that show a treatment doesn't work are less likely to get published).
As Ted noted, this has typically been reported as a last resort type of therapy. A major fear regarding the use of donated human feces is the potential for transmission of viral, bacterial, and parasitic infections among individuals. There are no guidelines as what kind of an individual is an appropriate donor. Furthermore, there is no consensus as to appropriate preparation and administration of fecal contents for biotherapy.
One of the major limitations of our understanding of the bacteria of the intestine has been our inability to grow many of the bacteria outside of the GI tract for experimentation. New molecular methods designed in the last few years, however, have provided scientists with the ability to identify different strains of bacteria in stool. The advent of these tools may help investigators understand more about how fecal biotherapy works and utilize these principles to design more mainstream therapy.