Here 's what another surfer responded to
that same text on another post
(curezone).
Here is some info on fecal flora
replacement, this mostly covers c diff but
it works for uc also. Mike
flora power"—fecal bacteria cure chronic
c. Difficile diarrhea
thomas j. Borody, m.D., f.R.A.C.P.,
f.A.C.G.A
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persky and brandt (1), in this issue of
the journal, amply demonstrated how normal
human flora bacteria are capable of
permanently eradicating c. Difficile from
the bowel. Lessons learned from this case
may have far-reaching clinical
implications. First, courage and an
innovative spirit are required to carry
out what was described by the authors as a
"distasteful" procedure. The description
reflects our cultural "fecophobia" and
might have been viewed quite differently
had the procedure been as routine as a
blood transfusion—conceptually similar,
but one that has largely lost its
"hemophobia." because the procedure is
neither routine nor accepted, it is often
dismissed even though it can be
dramatically curative. The main lesson,
then, is that patients with symptomatic,
incurable c. Difficile seeking out any
form of help (2) are perhaps often
maintained in a state of considerable
suffering while a safe, rapid, and highly
effective therapy is available to them
virtually anywhere in the world. Yet the
therapy is generally not discussed,
published, or popularized. Clearly, with
our patients' well-being in mind, this
area requires further improvement through
funded research and a scientific approach
to its practice.
The second clear lesson is the dramatic
and curative, effect of this treatment.
In eight reports (3, 4, 5, 6, 7, 8, 9,
10), the overall cure rate was 60 of 67
treated patients. Generally those
patients who failed to be cured were
treated late and died from overwhelming
pseudomembranous colitis (pmc) (4).
Clinical improvement usually occurred
within 1-4 days and has been reported to
be curative, without recurrence. In fact,
there are few medical therapies that
reverse severe illness so dramatically.
This begs the question as to how such
dramatic treatment works, and whether it
could be used or modified to cure other
bowel conditions that may be
infection-driven. Tvede et al.
Demonstrated in vitro how some but not
other bacteria can profoundly inhibit the
growth of pathogenic strains (6). A
similar although less powerful phenomenon
has been described for lactobacillus gg
(11). It would seem that inhibitory
substances, perhaps bacteriocins
elaborated by bacteria, possess powerful
antimicrobial properties. Unlike
available antibiotics, these substances
seem to have the added power of
eliminating bacterial spores. In
addition, the accompanying incoming mix of
bacteria implants missing flora components
such as bacteroides species, restoring
fecal physiology (10, 12), and deficient
composition (6, 13), which may have
initially permitted implantation of the
pathogen such as c. Difficile. Hence,
colonic infusion of enteric flora may
serve both as an antimicrobial and
replacement therapy.
The human fecal flora is a complex mix of
organisms and is arguably the largest
organ of the body, containing in a compact
mass of living bacterial cells almost nine
times more living cells than does the
entire body (14). Given the bacteriacidal
nature of fecal flora, as judged by the
>95% cure of c. Difficile, it is
instructive to realize that c. Difficile
may be but one of many implanted infective
agents mediating chronic gi disease. As
h. Pylori was found to be the infective
cause of ulcer disease, so chronic
clostridial (or other) infections may
cause a portion of chronic gi disorders
such as constipation, ibs, or ibd.
Indeed, constipation responds to
vancomycin (15, 16) and to fecal flora
therapy (17, 1
as does ibs (5,
19). Ulcerative colitis (uc) has also
been reported to go into prolonged
remission after fecal flora infusion (20).
We have confirmed this finding in our own
prospective series of now seven patients
with severe uc, five of whom remain in
clinical remission without therapy 1-10 yr
after treatment (19). In these
conditions, no specific bacterial
pathogens have yet been demonstrated.
Similarly, when eiseman et al. (3)
treated his four pmc cases in 1957, c.
Difficile had not been discovered—yet the
therapy was successful. This very finding
teaches us that we can use bacteriotherapy
to treat enteric infections without
necessarily identifying the pathogen.
Fecal bacteria home in on the pathogen,
apparently because of their broad-spectrum
activity. Hence, when the bacterial
species is unknown, fecal bacteria can
still dissect out the pathogen without the
need to detect and diagnose the infection.
Although scientifically it is satisfying
to recognize the pathogen, strictly
speaking this is not necessary. It is
therefore feasible that progress in
ibs/ibd treatment discovery could spring
from a successful therapy rather than from
pathogen identification.
For those contemplating the use of this
treatment, practical issues that stem from
the report by persky et al. Include a)
the method of treatment, and b) selection
of donor. It seems that the method of
delivery of the fecal slurry into the
bowel results in cure, whether given by an
enema suspended in saline (3, 4, 5, 7, 8,
9, 19) or milk (10, 12), by a small bowel
infusion via a nasoduodenal tube (5, 7), a
gastrostomy (9), or a colonoscope (persky
et al.). However, there may be advantages
delivering via a colonoscope to infuse as
proximally as possible, and to detect any
colonic pathology. Selection of the donor
is of crucial importance to avoid
infecting the recipient with a separate
disease. The donor should be tested at
least for hiv, hepatitis a, b, and c,
cytomegalovirus, and epstein-barr virus,
with stool negative for any detectable
parasites or bacterial pathogens. In our
experience, choosing the patient's partner
offers a theoretical advantage that any
transmissible disease would have been
transmitted and emerged by now.
In the future, it is conceivable that
"bacteriotherapy" using combined, selected
bactesial strains resembling human feaal
flora (6, 21, 22), perhaps in capsule
form, may become a curative therapeutic
agent for c. Difficile infection and
perhaps for those gi dismrders that we now
call "idiopathic" but that may well have
an infective etiology
