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What you need to know about fecal transplants

You’ve probably seen an increasing number of stories about the “wonders” of fecal microbiota transplants, the process of transplanting gut flora from a healthy donor to a patient suffering from Clostridium difficile infection (C. diff) that contributes to diseases ranging from diarrhea to colitis.

Fecal transplants may not be the perfect cure-all many patients are expecting, however. In fact, taking a multi-strain probiotic every day can go a long way toward preventing C. diff infections without the need for one.

Some background about C. diff

  1. Symptoms of this infection can range from inconvenient and mild (loose stools punctuated by abdominal pain or tenderness for a few days) to life-threatening and possibly fatal (loss of appetite, fever, weight loss, severe abdominal pain and even a hole in the intestines).
  2. Some 14,000 Americans die each year due to the effects of C. diff., out of 23,000 who perish due to antibiotic-resistant infections. Medical experts estimate 25 percent of patients who are treated for C. diff suffer recurrences, and half of them occur in stages.
  3. C. diff is a bacterium that resides in our intestines and, generally, will not cause harm because the normal, healthy bacteria in our gut will suppress its growth. The main reason C. diff becomes a problem: The overuse of antibiotics eliminate the good bacteria that fight infections.


After the success reported in a recent New England Journal of Medicine study conducted in the Netherlands, some medical experts believe fecal transplants have created “a lot of buzz for lots of illnesses” may show some potential for treating Parkinson’s disease, ulcerative colitis and celiac disease.

Simply put, the success of fecal transplants underscores the importance of good gut health that contributes to the total scope of health. But, do you really need one?

What follows are answers to common questions about fecal transplants.

Why have fecal transplants become so popular in treating gut health problems?

Fecal transplants have been shown to be safe and effective for C. diff-related diarrhea and colitis. It is known that ulcerative colitis and many other health disorders are related to an unhealthy balance of intestinal bacteria.  By giving a fecal transplant — which is really a “super probiotic” — it is possible to infuse healthy bacteria that can rebalance the intestinal flora and stop the immune mediated inflammation.

There are ongoing trials of fecal transplant for ulcerative colitis, irritable bowel syndrome (IBS), pre-diabetes, autism, obesity and other conditions. Some of the results have been very promising.

What are the primary causes of C. diff that have pushed gastroenterologists to prescribe fecal transplants?

C. diff is a bacteria that has become a common hospital-acquired infection, especially when a patient is given an antibiotic that disrupts the normal intestinal bacteria.

C. diff produces severe diarrhea and colitis which will respond to specific antibiotic therapy. Unfortunately, there is a significant risk of relapse of the colitis. Some patients have become critically ill, especially after their third or fourth relapse. Drastic situations require drastic care.

There were case reports of patients responding to fecal transplant dating back to 1958. The medical community knew that it might work, but the “ick” factor had made it an unattractive therapy.

In 2010, there were reports that greater than 90 percent of patients were cured after a fecal transplant. Given the serious nature of a C. diff infection and the safe and rapid recovery after fecal transplants, physicians are now embracing its use.

Are fecal transplants FDA-approved procedures?

No, they are not. It is a real problem in that controlled clinical trails need to be done with sick patients who have C. diff, giving half a real fecal transplant and the other half a placebo to prove there is a statistical improvement, and that there are no serious side effects. Studies are now underway.

Because of the severity of the illness and the noted benefits, the FDA has issued a statement that “fecal transplants be used only on patients with C. diff who have not responded to any other therapy, and only after doctors make sure the patient understands the approach is ‘investigational’ and has ‘potential risks’.”

How much do fecal transplants cost?

The current standard treatment for C. diff is costly since expensive courses of medications may need to be given a number of times and, even then, the patient may need to be hospitalized.

The cost for a fecal transplant depends on how the transplant is delivered. It can be given as a retention enema or through a colonoscope or nasogastric tube. I would think depending on the route given, the total cost would be less than $3,000.

Can probiotics help in ways that fecal transplants cannot?

Probiotics have been shown in clinical trials to lessen the risk of developing a C. diff infection if given during the course of the antibiotic. Probiotics can lessen the risk of C. diff multiplying and causing colitis. It wouldn’t make sense to give a transplant to a healthy patient taking a prescribed antibiotic.

How can probiotics help by preventing C. diff and avoiding fecal transplants?

Probiotic bacteria produce antibacterial proteins that kill C. diff bacteria and also inhibit it from adhering to the intestinal lining cells. These properties of probiotic bacteria prevent C. diff from multiplying and producing toxic substances that cause diarrhea and colitis.

Just a reminder, it’s important to know when to take probiotics and antibiotics to get the maximum benefits from both. Taking antibiotics and probiotics two hours apart lowers the risk of the former, eliminating the live and beneficial probiotic bacteria that preserve and protect your gut health.

Photo source: CDC’s Public Health Image Library

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