A bitter pill to swallow

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Advances by a research team led by Dr. Elizabeth Hohmann at Massachusetts General Hospital in Boston may mean a simpler, safer, alternative to the highly effective fecal transplant for the treatment of recurrent Clostridium difficile infection. I’m sure by now that you have heard about fecal transplants. Studies have found that replacing the gut microbiota of an individual suffering from debilitating C. difficile infection, with the microbiota of a (related, or co-habiting), healthy individual can completely abolish the infection. Often, after a single treatment. This treatment has been found to be so effective that people have taken the risky decision to perform DIY versions on themselves.

The microbiota replacement is achieved by fecal transplant.

Feces from the healthy donor is liquefied with saline and delivered into the colon of the infected individual either via a tube in the rectum or a tube inserted through the nose. The process is costly, time consuming and requires thorough screening of the donor samples.

In a small feasibility study published in the Journal of the American Medical Association this week 1 Youngster et al., detail their method of delivering frozen fecal matter orally via capsule.

The group collected stool samples from healthy volunteers and screened them to ensure they contained no pathogens. The samples were mixed with saline and filtered. Glycerol was added to protect the bacteria, the mix was piped into capsules and put into the deep freeze.

Patients receiving the treatment were aged 7-90 years old and had suffered at least 2 recurrent C. difficile infections that antibiotics had failed to control and resulted in hospitalization. Twenty participants received the capsules. After one round of dosing (2 days, 15 capsules per day), diarrhea cleared up in 14 patients, who remained symptom free 8 weeks later. The remaining six patients were retreated, and symptoms cleared in 5 of those - a 95% success rate. Furthermore, no serious side effects were observed. Not even vomiting that the group thought was likely during the first 24 hours.

The study was small, but it was overwhelmingly positive and paves the way for larger clinical trials and lends hope to cheaper, safer, effective treatments for those suffering recurrent C. difficile infections.

  1. Youngster, I. et al., (2014) Oral, Capsulized, Frozen Fecal Microbiota Transplantation for Relapsing Clostridium difficile Infection. JAMA. Published online October 11th. doi:10.1001/jama.2014.13875