Would you ever agree to a procedure called ‘faecal transplantation’? It sounds strange, even disgusting, but it has proven an effective treatment for a certain kind of colonic infection. Dr MN Rajabally, a gastroenterologist at Mediclinic Constantiaberg, tells us more.
Why would a patient need a faecal transplant?
Research evidence shows that faecal transplantation works in treating Clostridium difficile colitis. C. difficile is a bacterium that can be picked up during a hospital stay by a patient who has received antibiotics. Antibiotics alter the gut microflora (micro-organisms living in the digestive tracts) in a way that allows C. difficile to populate and cause inflammation of the colon. C. difficile spreads via spores shed by an infected patient. It’s a major infective risk in hospitals worldwide.
Is the procedure used for anything else?
The FDA has only approved faecal transplantation for the treatment of recurrent relapsing C. difficile. It’s been reported, however, that it has been used in the treatment of ulcerative colitis, irritable bowel syndrome and constipation. But these cases were still experimental – faecal transplantation has not been approved as standard therapy for the conditions mentioned.
What are the alternative treatments for a relapsing C. difficile infection?
We normally use antibiotics that mainly target the colon. A number of new antibiotics have come onto the market, including Rifaximin and Fidaxomicin. Although these antibiotics perform slightly better than conventional ones, the chance of a relapse after using them is still significant when compared to faecal transplantation.
What risks are associated with faecal transplant?
The main risk is the transmission of infection from the donor to the recipient. This is why a rigorous donor screening is necessary. The infections that are screened include HIV, viral hepatitis, syphilis and other intestinal infections – including parasites.
How do you source donors?
A donor is usually a close relative of the patient, preferably living in the same household. We usually look for spouses or partners but it can be any healthy adult. A thorough screening is imperative regardless of the donor.
How is a faecal transplantation administered?
There are two methods of administration – either with a nasogastric tube or with a colonoscope. The advantage of the colonoscopic route is that the treatment is delivered right where the pathology is without having to travel the whole length of the small bowel, which can range between six and eight metres. However, a Dutch group who published their data in 2013 obtained good results with the nasogastric tube.
Who is qualified to perform the transplant?
This has to be done by a physician who is trained in evaluating the indications for the procedure, the screening of the donor and the administration of the transplant. Most times, gastroenterologists have done it.
I’ve read that it can be done at home. Is this a good idea?
Absolutely not. Faecal transplantation is a highly specialised procedure and the process has to be done by a professional. Don’t try this at home!
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