‘Gut bug’ transplants tested for many conditions

Correction: An earlier version of this article gave the incorrect first name for Lawrence Brandt. This version has been corrected.

October 9, 2011

For more than a year, Linda Devens was tormented by chills, fevers and, worst of all, unrelenting bouts of diarrhea that required repeated hospitalizations.

“I was literally living in the bathroom,” said Devens, 61, of Andover, Minn. “I wouldn’t wish it on anyone. It was really awful.”

Devens was hit by an increasingly common bacterial infection that is getting harder to beat back with antibiotics. Some victims of Clostridium difficile eventually need part of their colons removed. Some die.

A crazy idea

In Devens’s case, she finally agreed to what initially sounded like a crazy idea: getting her digestive system microbes replaced by someone else’s.

A small coterie of doctors in the United States, Europe and Australia have begun doing this for conditions suspected of being caused by disruptions in a healthy “microbiome,” the collection of microorganisms that populate everyone’s body.

The usually last-ditch procedure involves patients flushing out their digestive systems as if they were going to have a colonoscopy. Then, doctors inject microbe-laden feces from a healthy donor — often a spouse or relative — who has been screened for HIV, hepatitis and other disease-causing germs.

The procedure, known as a fecal transplant, has been performed most often and produced the most promising results in patients with “C. diff,” which often strikes people who have taken antibiotics, disrupting the normal protective colonies of organisms in their digestive tracts.

Some doctors report helping between 80 percent and 95 percent of recipients, frequently providing nearly instantaneous relief to those who had almost given up hope.

“In my mind, there is no doubt this is a very effective way of treating this,” said Alexander Khoruts of the University of Minnesota, one of a group of doctors publishing guidelines for the procedure in the December issue of the American Gastroenterological Association’s journal.

While Khoruts currently limits the procedure to C. diff patients, some doctors have begun trying the transplants for other conditions, including Crohn’s disease, ulcerative colitis, irritable bowel syndrome and even obesity.

“I think we are just at the very beginning of understanding the contribution it may make,” said Lawrence Brandt of the Albert Einstein College of Medicine in New York, who plans to report the results of transplants on 75 patients to the American College of Gastroenterology meeting in Washington Oct. 28-Nov. 2.

Some European physicians have begun using the procedure for an array of conditions, including autoimmune diseases such as Type 1 diabetes and a disorder associated with obesity called the metabolic syndrome. An Australian doctor has gone even further, using the procedure on patients with ailments such as multiple sclerosis and the neurological condition myoclonus dystonia.

“I think we have cracked something where we can solve many conditions and help a large section of mankind just by healing damaged flora,” said Thomas J. Borody of the Centre for Digestive Diseases in Sidney, who plans to describe several of his cases at the gastroenterology meeting in Washington.

Call for more research

Many experts, however, caution that much more research is needed beyond the largely anecdotal reports so far.

“We haven’t actually proved the fecal transplant is what is making them get better. The proof would have to come from a rigorously controlled randomized trial, which hasn’t been done,” said Robert Karp of the National Institute of Diabetes and Digestive and Kidney Diseases.

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