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Wednesday, January 19, 2011

I Am Donating My Poo For You!

Scientists fight bugs with poo

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A toilet is seen in New York April 29, 2008. REUTERS/Lucas Jackson
LONDON | Wed Jan 19, 2011 7:47am EST
(Reuters) - Once a year, every year, Professor Thomas Borody receives a single-stem rose from one of his most grateful patients. She is, he says, thanking him for restoring her bowel flora.
It's a distasteful cure for a problem that's increasingly widespread: the Clostridium difficile bug, typically caught by patients in hospitals and nursing homes, can be hard to treat with antibiotics. But Borody is one of a group of scientists who believe the answer is a faecal transplant.
Some jokily call it a "transpoosion." Others have more sciencey names like "bacteriotherapy" or "stool infusion therapy." But the process involves, frankly, replacing a person's poo with someone else's, and in the process, giving them back the "good" bugs they desperately need.
Borody's grateful patient, Coralie Muddell, suffered months of chronic diarrhoea so bad she would often embarrass herself in public, and had even stopped eating to try to halt the flow.
The technique that cured her has had a success rate of around 90 percent in the experimental cases where it has been used so far. Now scientists are taking it to the next level, with randomized controlled trials to establish if it can really be a viable option when antibiotics have failed.
With rates of hospital-acquired C.difficile infection rising in the United States, Europe and other parts of the world, that could save lives as well as reducing expensive days of extra care. "There's rising recognition of how effective this is," Borody, a Sydney-based gastroenterologist, told Reuters.
YUCK FACTOR
There's little doubt this treatment has an image problem. Feces, including important bowel flora, is transferred from a volunteer donor -- screened to limit possible other infections -- into the colon of the infected patient. The treatment can be administered by a colonoscope or an enema, or by the mouth or the nose.
"I used to be frowned upon and called 'the doctor who makes people eat shit'," says Borody, whose scientific papers have included such titles as "Flora Power" and "Toying with Human Motions." But he is also deadly serious. One of his published studies reported that in patients with recurrent C.difficile infection, 60 out of 67 -- 90 percent -- of those who received faecal transplants were cured.
Alex Khoruts, a gastroenterologist at the University of Minnesota Medical School in the United States, agrees that the science is not to be sniffed at. "The data are very strong," he said in a telephone interview. "There is no question that it works."
Khoruts published a study in the Journal of Clinical Gastroenterology in 2009 that showed a single infusion of feces reversed the absence of bacteroides -- a group of bacteria vital to the body's ability to withstand infections with C.difficile.
Khoruts often sees patients who have taken course after course of antibiotics. As soon as the treatment stops, the infection returns. It doesn't take much for these sufferers to listen to a new treatment idea, even if it involves feces.
"The patients I see don't have any qualms about it," he says. "By the time I see them, they've often been sick for anywhere from six months to two years, so they're quite desperate. Nothing really scares them."
The main aim, he says, is to keep the poo pure.
"What we try to do is preserve it as close as possible to how it was in the donor. There's no in-between culture or enrichment. We want to transfer as much as we can intact."

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