Clostridium difficile infections have nearly doubled over the past 15 years – currently there are 700,000 cases per year. We are now seeing 50% of cases where antibiotics have not been identified as triggering the infection – this means the patient picked the infection up by touching and then swallowing C. diff spores in public bathrooms or in hospital and nursing home rooms. Up to twenty percent of patients have relapsing symptoms or fail antibiotic therapy. Fortunately, there is a highly successful treatment for patients, which involves something many people would never have thought could work (or imagined having it done to them). Fecal microbiota transplant (FMT) resolves the infection in roughly 90% of all patients. See the FAQs below and a patient testimonial.
For more information or to schedule an appointment, call us at 314-996-3627 or contact us online.
Fecal microbiota transplant also known as fecal transplantation or stool transplant is a medical procedure where stool is collected from a healthy tested donor, strained and then transferred into a patient suffering from C. difficile infection. Fecal microbiota transplant is performed for patients with recurrent or severe C. diff. infections when antibiotic therapy has failed.
Bacteria and other microorganisms are always present in the GI tract and many are necessary to maintain good health (we have 100 trillion bacteria in our intestines). Antibiotics can disrupt the balance in the GI tract and allow infectious bacteria like C. diff to take over. A fecal microbiota transplant involves placing good bacteria back into the colon to stop the overgrowth of C. diff. This “bacterial broth” is basically an immense probiotic treatment.
A gastroenterologist transfers healthy donor stool and saline into the colon the patient during a colonoscopy. At Missouri Baptist our gastroenterologists prefer performing FMT during a colonoscopy, which appears to have a higher success rate than other methods (enema, nasogastric tube or upper endoscopy). During the procedure, you will be given an IV with a sedative to make you relax and fall asleep. You should not feel anything during the procedure. This is performed most often in outpatients but inpatients are candidates as well.
Most patients look to family as donors, but any healthy person may donate. The best donor is a healthy first degree relative.
Once a donor has been found, the donor must be screened and tested to make sure their stool is healthy. The donor cannot have any of the following:
Currently there are no documented cases of infection transmitted through a fecal transplant procedure. Donors are extensively screened and tested to be sure there are no signs of infection in the blood or stool. Donors are not allowed to have gastrointestinal diseases, autoimmune diseases, or the metabolic syndrome that might allow the patient to acquire a disorder caused by an interaction of the bacteria and the patient’s cells.
Risks of developing autoimmune diseases may be reduced when your donor is a relative. While all donors are screened to make sure they are healthy and carry no diseases, an unrelated donor may have bacteria that do not interact well with your own genetics. If possible, a donor who is a parent or child works best.
Fecal microbiota transplant has a 93-84% success rate treating recurrent C. diff infection in patients in the United States. A recent study showed patients who had am FMT via a colonoscopy experienced a 93% success rate, compared to nasal tube or enemas, which were only 86% and 84% respectively. Only colonoscopy transfer is approved at MO Bap.
Generally, patients feel better within two days.
Valentine’s Day was anything but romantic for Victoria. She had been suffering from Crohn’s Disease for a decade already, and Feb. 14, 2014, her symptoms were even worse. “I couldn’t leave the bathroom,” she admitted.
Victoria, 67-years-old, is from the St. Louis area and had been seeing Dr. Leonard Weinstock for her Crohn’s disease for years. A few days after she had lunch with her aunt at a nursing home she started having diarrhea. When she came to him with her new symptoms, Dr. Weinstock determined it was Clostridium difficile, or C. diff. “I had heard of c-diff because a friend of mine lost one of her friends to c-diff,” she said. “So I was scared.”
They tried a variety of antibiotics for a few months. “They would work for a little bit, then they wouldn’t work anymore, and it was right back to square one. I’d finally feel better, go back to work, and then the symptoms would start again.”
Dr. Weinstock told Victoria about a new treatment option, a fecal transplant. “I thought it sounded gross,” said Victoria. “But I would have done anything by that point. I’d had enough.”
In July, Victoria was the first Missouri Baptist patient. She said, “I was so relieved; I didn’t want to go anywhere else. I wanted to do it at Missouri Baptist.”
Victoria’s 30-year-old daughter agreed to be the donor. “She wanted to make me feel better so bad, and she did,” says Victoria. “I’ve been in remission, and I’ve had no problems since. I was at the mall just a couple days later. I couldn’t do that before. And I’m back at work.”
Victoria missed weeks of work because of her c-diff. “It’s embarrassing to explain why I had to miss so much work, but after my transplant, I finally told my boss what was going on. She had heard of c-diff, but she had never heard of fecal transplants.”
“There’s a great need for this procedure,” says Dr. Weinstock. “C-diff is a terrible disease and can be fatal. This quick procedure is life-changing and life-saving. I have had 8 patients who had to go out of state to get this treatment and they all got better.” Dr. Weinstock said that getting the FMT program going at MBMC has taken a lot of effort of many people especially Dr. Michelle Woodley and Endoscopy Manager Jane Miller, RN. The hospital has bent over backwards making this affordable for the donors – in fact the donors are not charged at all for extensive blood and fecal testing. The treatment can cost as much as $2000 at other institutions.