Ohio hospitals now performing fecal transplants for patients with stubborn cases of C. diff
CLEVELAND, Ohio -- At least three Ohio hospitals now offer fecal transplants as a way to cure patients of the debilitating and sometimes deadly infection of the colon known as C. diff, short for Clostridium difficile.
Ohio State University’s Wexner Medical Center in Columbus announced last week that the medical director of its Inflammatory Bowel Disease center recently performed two of the transplants.
Afterward, the Cleveland Clinic and MetroHealth Medical Center in Cleveland acknowledged that doctors there have also performed fecal transplants on a limited number of patients and will continue to offer them despite the procedure’s high “ick” factor.
That’s because fecal transplants — depositing feces from a healthy person into the colon of someone who is sick — work.
“It’s just unbelievable how effective they are,” says Dr. Michelle Hecker, an infectious disease specialist at MetroHealth Medical Center who coordinated the fecal transplant there.
In addition, recent changes in federal regulations eliminate tedious paperwork that was previously required to perform the procedure on patients with repeated bouts of c. diff, which can cause cramps, abdominal pain and diarrhea so frequent and severe it keeps people from their daily activities.
Research shows that more than 90 percent of patients with recurrent C. diff — infections that do not respond to antibiotics — get better after fecal transplants.
The transplants aren’t major surgery. They’re typically performed under sedation using a colonoscope and are much less expensive than hospital stays and month after month of heavy-duty antibiotics such as Vancomycin, which can cost $1,200 for a 10-day supply. Other antibiotics are even more expensive. And they often don’t work.
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Fecal treatment dates back to at least the 4th century when a traditional Chinese medical doctor prescribed drinking liquefied feces as a treatment for severe diarrhea and food poisoning.
It has been used in veterinary medicine for decades and, over the past 15 years, has taken hold for human use as cases of C. diff skyrocketed in hospitals and nursing homes.
C. diff is difficult to control because its hardy spores can survive for months on sheets, countertops, curtains and other surfaces. It often afflicts those who’ve been on antibiotics. The drugs fight off infection and, in the process, kill off good gut bacteria that prevent C. diff from growing out of control.
Every year, about 500,000 people in the United States contract C. diff and an estimated 14,000 to 30,000 die from it. The disease contributes to another 100,000 deaths annually in this country.
Until recently only 15 or so doctors in the United States made fecal transplants an established part of their practices, according to Dr. Colleen Kelly, a gastroenterologist from North Olmsted who teaches at Brown University’s medical school and has been performing fecal transplants for years.
More doctors now perform the procedure because scientific studies are showing how effective it is and a recent U.S. Food and Drug Administration statement does away with required paperwork in some cases.
On June 17, the FDA issued a statement loosening regulations – while it formulates a new policy – on fecal transplants for stubborn C. diff cases. That allows doctors to perform the procedure after a patient or his or her legal representative signs a consent form that explains that the treatment is investigational and has potential risks.
One of those risks is the transfer of some other infection from the donor to the recipient.
“But there’s been no report of a significant side effect from this,” says Dr. Razvan Arsenescu, the gastroenterologist who performed the transplants at Ohio State.
The FDA made the change after doctors expressed concern that the regulation was keeping patients who desperately needed transplants from getting them.
Arsenescu, medical director of the Inflammatory Bowel Disease center at Wexner Medical Center in Columbus, says both patients he treated at OSU were relieved of symptoms within days. One of them had been sick for eight years.
“They had to miss a lot of work, they incurred a lot of expenses, it significantly affected their social lives,” Arsenescu said.
“They were challenged by this in every way.”
Like other doctors, Arsenescu tested the donors’ blood for HIV and hepatitis B and C and their stool for parasites and viruses, diseases that could potentially be transferred to the recipient.
Often family members serve as donors, but other healthy people can provide the stool, which is mixed with saline before it’s implanted in the colon.
MetroHealth performed its first fecal transplant in April, Hecker said. The elderly patient fully recovered and is off the antibiotics he had been taking for years to keep the disease at bay.
The Cleveland Clinic has performed about 10 fecal transplants in the past two years, said Dr. John Fung, a transplant surgeon and chairman of the Clinic’s Digestive Disease Institute. Those patients all recovered.
For now, all three hospitals will perform the transplants on patients who’ve had several bouts of C. diff that haven’t responded to antibiotics.
But doctors at the institutions say they hope to offer the treatment for other diseases in coming years.
“We are looking at starting a clinical trial for inflammatory bowel disease,” says Arsenescu. That includes Crohn’s disease and ulcerative colitis.
“I hope that we can someday expand the use of fecal transplants to help patients with other autoimmune diseases — I’m thinking multiple sclerosis, lupus and metabolic disorders like obesity and diabetes.”
Research indicates that fecal transplants may help people with obesity.
As Hecker says: “There’s a lot of interest in all kinds of aspects of how the bacteria in our body may help us be healthier.”