Is fecal transplant a safe method of gut disease treatment?

Are fecal transplants safe?

Fecal transplants have become a standard process for the treatment of CDI in the USA and it is considered as 90% effective at present. With the growing number of patients opting for this treatment, it is being estimated that it can become the primary defence against CDI.

In the USA, the annual number of recurrent C. difficile infections is rising at a rapid rate. Around 30 percent of the patients treated with antibiotics see the return of the infection within a few weeks.

With the rise in antibiotic resistance, new drugs are arriving in the market but medical experts believe that fecal transplants can be a solution to the problem. It is also to be noted that antibiotics also destroy the helpful organisms present in the gut and fecal transplants are an effective way to reintroduce them in the system.

How does fecal transplant happen?

The first step that is taken for a fecal transplant is that the donors are checked to ensure that they are healthy and free from diseases. The following steps are taken for the necessary checking in this regard.

• Checking for any antibiotic exposure in the past six months
• Any problems related to immunity
• Any tattooing or body piercing in the past six months
• Checking for any history of drug use
• Any recent travel to endemic areas
• Whether there is any presence of chronic gastro-intestinal disorders, such as inflammatory bowel disease.

The donors are also made to undergo blood and stool tests to check for any specific infections that might be present. The blood tests involve Hepatitis A, B, and C serologies, HIV and RPR. The stool tests involve Ova and parasites, C. difficile PCR, culture and sensitivity and giardia antigen.

Once the donors are checked the fecal transplant treatment takes place. The process is generally conducted by the method of colonoscopy in which a tube is introduced into the large intestine.

The donor stool is mixed with a saline solution and is introduced into the colon through the colonoscope. Patients are generally provided with sedative drugs so that they do not feel any pain or discomfort during the process.

There is also the practice of using a nasoduodenal tube which enters the intestine through the nose. In some cases, an enema bottle or bag.is used to inject the stool through the rectum. The patients are also advised to hold the stool for as much time as possible after the procedure. This will lead to the best possible results from the treatment.

How does fecal transplant work?

The record of the first fecal transplant dates back 1700 years to China, where it was used by a physician called Ge Hong to treat conditions like food poisoning and diarrhoea. There are also records of German soldiers treating themselves with camel faeces to treat diarrhoea during World War I. The exact method by which the process works is yet to be determined and more research is required.

The research on the various bacteria present in the gut is still in a nascent stage. Since the overall health of the gut affects the entire health of a person, it is possible that fecal transplant can impact a variety of health conditions.

Some research has suggested that the fecal microbial transplant can help in curing various conditions, some of which are listed below.

• Diabetes
• Chronic fatigue syndrome
• Fibromyalgia
• Obesity
• Mood disorders, such as depression
• Non-alcoholic fatty liver disease
• Arthritis
• Asthma
• Eczema

A significant percentage of the faeces contain bacteria while the rest of the part is undigested nutrients, electrolytes, pigment and mucus. The total number of microorganisms in the human gut can be beyond 100 trillion and these consist of not only bacteria but also, quadrillion viruses, fungi, parasites, and archaea.

The composition of gut microbiota varies in each person and it is dependent on the environment, food, lifestyle, hygiene preferences and also on the consumption of antibiotics. The organisms play an important role in the absorption of nutrients, generation of intestinal epithelium, the functioning of the immune system and in the maintenance of tissue homeostasis.

So maintaining the right healthy microbial community in the gut and restoring any imbalance through fecal microbial transplant can be an effective way to restore health.

Research data regarding fecal transplant

Research suggests that antibiotics can affect the overall composition of gut microbiota and create an environment that is ideal for the germination of C. difficile spores. This leads to an increase in the number of the pathogen. After the fecal transplant, the recipient’s fecal bacteria composition resembles that of the donor within a period of two weeks.

This makes C. difficile compete with the other bacteria for a limited amount of nutrients which makes it difficult for them to thrive. The introduction of new elements in the huts through the process also affects the overall life cycle of C. difficile.

The research data supports the use of fecal microbial transplants for treating the cases related to uncomplicated CDI. The process has proved effective for diseases like IBS, abdominal pain, bowel habit, dyspepsia and bloating.  Fecal transplants have not proved much effective for treating IBD as  IBD is more complex in nature and involves the interplay of various pathological factors.

At the same time, the process is dependent on a number of factors like donor selection and screening, the exact quantity of infused material, long term effects and others. There are many unanswered questions about the procedure which demands more research work.

Risks around Fecal transplant

The process is often associated with symptoms like discomfort, bloating, flatulence, diarrhoea, constipation, vomiting, and transient fever.

This is quite often due to the method of introduction rather than the process itself. These symptoms are self-limiting and get cured within a few days. Individuals with HIV, advanced liver disease or those who have undergone a bone marrow transplant should not undergo this process.

There is no data available on the long term effects of the transplant, especially on the immunity of the recipient. The change in the composition of the gut microorganisms can lead to diseases like obesity, diabetes, atherosclerosis, IBD, colon cancer, non-alcoholic fatty liver disease, IBS and asthma in the long run.

There is also the risk for the transfer of conditions like multiple sclerosis and Parkinson’s disease through the process. There have been some cases where a viral transmission had been reported after the process of fecal transplant but no definite evidence has been found.

Those who are doing the transplant at home without the use of proper screening methods are also risking HIV and hepatitis infections. The transfer can also lead to conditions like sleep disorders and anxiety. Presently, research is being done on the long term effects of the process and the processing power of artificial intelligence is also being used to analyse the various roles of gut microbes in detail.

There are also psychological factors involved with the process with many people considering it to be a “dirty” practice. The FDA has also suggested that patients planning for a fecal transplant should seek the necessary advice from their health care provider before undergoing the process.

Conclusion

The whole concept of fecal transplantation treatment can sound peculiar to many but medical evidence shows it to be effective in many cases. Since the process may result in some unexpected side effects, standardizing it as a regular treatment is quite challenging for medical professionals.

For any individual suffering from a painful or a life-threatening disease, this can be a lifeline that may bring him or her back to a normal life. At the same time, the process is not free from risks and it is necessary to seek expert advice before going for it. There are not many doctors who are aware of the latest developments in the area of fecal transfer and hence seeking out the right expert is also necessary.

Fecal transplants offer a promising direction in curing the conditions related to C. difficile infections but further research is needed to make it safer and more effective in the long term.

References
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895930/
2. https://www.hopkinsmedicine.org/gastroenterology_hepatology/clinical_services/advanced_endoscopy/fecal_transplantation.html
3. http://www.isrctn.com/ISRCTN74072945?q=&filters=recruitmentCountry:United%20Kingdom,conditionCategory:Digestive%20System&sort=&offset=52&totalResults=345&page=1&pageSize=100&searchType=basic-search
4. https://geneticliteracyproject.org/2019/10/18/15-things-to-know-about-fecal-transplants-heres-the-straight-poop/#

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