Don’t Read This Column With Your Morning Coffee
06 May 2010
Would you consent to have another person’s fecal matter inserted into your body? It’s a repugnant thought, particularly if you’ve decided to read this column at breakfast. But this procedure is being done and it’s curing patients who suffer from Clostridium difficile infection, a troublesome recurrent bowel problem. So where do you pick up this infection and how is fecal material transplanted?
John Dillinger, the notorious bank robber, was once asked why he robbed banks. He replied, "It’s where the money is." Today if I asked infectious disease specialists where C. difficile is they would reply, "It’s in the hospitals." So don’t forget this fact if you need hospital care.
C difficile is not a rare problem. A report in the Journal of Pediatric Pharmacology claims that 15-20 percent of patients receiving antibiotics develop antibiotic diarrhea. Another report from the Mayo Clinic says that every year three million North Americans develop C. difficile infections.
We have millions of bacteria living in our large bowel usually at peace with one another. Studies show that about 3 percent of adults and 70 percent of healthy infants also have C difficile present in their intestines.
But when antibiotics are prescribed to treat pneumonia, ear infections, bladder or sinus infections, they often upset the balance of power between bacteria. This allows C difficile to increase and produce a toxin that causes diarrhea. The same result would happen if hunters killed all the wolves and allowed deer to multiply.
The diagnosis of C. difficile is made by examining a stool sample to detect its presence or its toxin.
Treatment in most cases is to discontinue the offending antibiotic. This allows normal bacteria in the bowel to recover and is successful in about 25 percent of cases. Or other antibiotics may be needed in an attempt to kill C. difficile. But in spite of treatment about 10 to 20 percent of patients have recurring bouts of disabling pain, diarrhea and skin irritation. And during an epidemic of this infection in Quebec 700 people died from it.
So although fecal transplantation is hardly a breakfast topic, you wouldn’t quickly turn it down if you’re having 40 bowel movements a day.
Dr. Thomas Louie, head of infectious disease at Foothills Hospital, Calgary, has now preformed 40 fecal transplantations. As you would suspect many doctors "pooh- poohed" the idea! Or, facetiously asked how much he had to pay the donors! But donors are usually parents, spouses, siblings or relatives. Their stools are then tested to rule out hepatitis infection, HIV and screened for parasites and C. difficile infection.
The collection technique is easy. Stools are collected for three days, placed in a plastic container, (obviously with a very snug lid), and placed in the refrigerator. Later in the lab the stool is passed through a screen, mixed with saline solution and cysteine to preserve organisms that may be destroyed by oxygen.
It’s not surprising that when Dr. Louie first proposed this idea hospital administrators were not amused. No doubt they conjured legions of lawyers arriving on their doorstep in the event of medical complications.
Now, Dr. Louie and his wife, who is a nurse, go to patient’s home to administer the enema. While researching this column I thought "thank goodness Dr. Louie had the good sense to have a spouse who is a nurse". I can just guess the reaction if he asked a non-medical wife, "Dear, today I’d like you to go with me to administer a fecal enema". I’d predict a very short marriage.
The fecal enema is given slowly over a 45 minute period. One third of the enema is then removed and the rest remains in the colon overnight. Dr. Louie reports that his success rate is 96 percent in restoring normal bowel function.
Dr. Louie says he’s aware of a few U.S. doctors who are using fecal transplantation to treat recurrent cases of C. difficile. And that this procedure has been more commonly used in Europe and Scandinavian countries.
My congratulations to Dr. Louie and his wife for their labours. And I hope you have not read this column on a full stomach!
