Fecal transplants: a new treatment for IBD
Whether fecal microbiota transplants increase the risk for other diseases over the long haul remains unclear.
Linda Ann Sasser has had ulcerative colitis since she was 20, but it wasn’t until May 2019, about 30 years later, that her condition hit a low point: not only did she have a major flare-up of chronic inflammatory bowel disease (IBD), but on top of it, she had Clostridioides difficile (or C. diff), a highly contagious bacterial infection that causes severe diarrhea and inflammation of the colon. “I became really, really sick with bloody diarrhea 30 times a day and chronic stomach pain,” Sasser says. While hospitalized for 12 days, she was given oral steroid medications, which didn’t help, then IV steroid medications, which gradually improved her ulcerative colitis flare-up. The next challenge was to treat the C. diff infection. The doctors tried antibiotics, which didn’t get the job done; Sasser’s abdominal pain was incessant, and the diarrhea would come on so suddenly that she often couldn’t get to the bathroom in time. “I was at the point where I said, ‘Just take out my colon,’” she recalls. Her doctor told her about another treatment that might help: fecal microbiota transplantation (FMT), which is exactly what it sounds like: fecal matter (as in: stool) from a healthy donor is transplanted into the body of someone like Sasser in the hope that it will improve her health.
Sasser didn’t hesitate to opt in, because nothing else had worked for her, so she had FMT through a colonoscopy. The first try didn’t work, so four days later, she had a second FMT procedure, which worked splendidly. “After the procedure, it was a breath of fresh air to not have blood in my stool or stomach pain, and I had normal poops for the first time in my life,” says Sasser, now 51, who owns a dog-grooming business in Sparta, N.C. “The transplant cured the C. diff and made the colitis 100 times better. It has really changed my life.”
That successful treatment stems from a new understanding and appreciation that’s emerged in recent years about the role gut bacteria play in human health. The gut is home to trillions of microorganisms—including bacteria, viruses, fungi and other microbes—that influence everything from digestion, metabolism and immune function to the development and progression of diseases like obesity, diabetes, inflammatory disorders, cancer, arthritis and depression. The presence of a diverse array of helpful microorganisms in the gut contributes to good health and homeostasis. By contrast, when an imbalance occurs in the microbiota population—whether it’s because of a loss of beneficial micro-organisms, an increase in potentially harmful ones and/or a decline in the overall diversity of microbiota—this leads to what’s called dysbiosis. Think of a lush and thriving garden that is home to a variety of plants, flowers and trees that is overtaken by weeds and fungi—that’s the equivalent of dysbiosis in the gut microbiome. (The microbiome refers to the billions of bacteria that live inside the human digestive tract.) “Any imbalance in the microbiome will cause inflammation and influence pro-inflammatory cascades in the body,” explains Dr. Amy Barto, an associate professor of gastroenterology at the Duke University School of Medicine and director of its Fecal Microbiota Transplantation Program.
Now doctors and researchers are harnessing the power of the microbiome, treating certain gut infections like C. diff and other recalcitrant medical conditions through fecal microbiota transplantation. “FMT is the ultimate mega-probiotic—an entire microbial ecosystem is transplanted and able to restore or restructure the gut microbiota,” says Dr. Monika Fischer, a gastroenterologist and an associate professor of medicine at Indiana University in Indianapolis.
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