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Stool transplant cures C diff in gut

18th January 2013

Researchers in the Netherlands have found that infusing patients with persistent intestinal infections linked to the superbug Clostridium difficile with the faeces of a healthy person works far better than other currently available forms of treatment.

c diff

The unconventional approach was part of traditional medicine systems in Europe and China, and is winning greater support among doctors and patients, as antibiotic resistance spreads.

Writing in the New England Journal of Medicine, the researchers said a stool transplant had a cure rate of 94%, three times greater than the cure rate in patients who only took antibiotics.

In a randomised clinical trial led by Els van Nood of the University of Amsterdam Department of Internal Medicine, researchers delivered freshly excreted stool in a saline solution via a nasal tube that led down to the small intestine to 16 patients, 13 of whom were cured after the first treatment.

Out of the remaining three, two more were cured after a second treatment, compared with 31% cure rate among those who took only antibiotics, while only 21% of patients given colonic lavage and antibiotics were cured.

Van Nood said the team had not expected the difference in outcomes to be quite so marked.

Currently, the antibiotic vancomycin is routinely prescribed for such bowel conditions, which are commonly found in elderly patients in community and care home settings, and can lead to persistent diarrhoea, nausea, fever and even death.

Researchers ended the trial earlier than anticipated, so as to give the patients in the control groups the remedy.

According to gastroenterologist Lawrence Brandt of the Albert Einstein College of Medicine in New York, using faeces as a medicine is a strange concept to get used to, because we are taught to regard excrement as dirty.

Brant has carried out the treatment for 14 years at his clinic, but did not take part in the study. He said the findings could herald a "new chapter" in medicine.

C difficile infections are rife among older people in care settings, and the misery of recurrent infections made many of the study participants far more willing to try the treatment.

The success of the treatment is thought to be linked to the diversity of microorganisms that live in a healthy gut. If it is developed further, researchers hope it may also lead to treatments for anorexia and irritable bowel syndrome.

"Good" gut bacteria have evolved in a symbiotic relationship with humans over millions of years, and have a profound influence on health, affecting muscular function, mood, immune system performance and even our metabolic rate, according to Brandt.

The Dutch researchers found, when they tested the patients' stool before and after the faecal infusion treatment, that there were more microorganisms present, and in greater diversity, the healthier the patients became.

C difficile thrives in community settings, where it survives externally for weeks or months, and can easily invade the body of a patient who has recently taken antibiotics, which kill off intestinal flora.

The 4th century Chinese physician Ge Hong is the earliest known proponent of the treatment, which he recommended for the treatment of food poisoning and severe diarrhoea.

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