Frankfurt (dpa) - "Faecal therapy" for recurrent diarrhoea does
not exactly sound appealing, so "stool transplant" is now the
treatment's usual name. "Bacterial transfer" is even more
inoffensive.
Whatever it is called, inserting faecal material from a healthy
person into the gut of a patient is currently "one of the most
interesting topics in gastroenterology," according to the German
Society for Digestive and Metabolic Diseases.
"It's still an experimental procedure," noted Peter Galle, a
gastroenterologist at the Mainz University Medical Centre in Germany,
who pointed out that little data had been gathered so far and many
questions remained. "The approach is promising, however."
Early this year, doctors at the medical centre of the University
of Amsterdam in the Netherlands published a study in the New England
Journal of Medicine that raised eyebrows around the world. It dealt
with people infected with the aggressive diarrhoea-causing bacterium
Clostridium difficile, which can inflame the lining of the colon and
lead to dehydration, loss of appetite and weight loss.
The bacterium is resistant to many antibiotics, and illness from
C. difficile, although rare, can be fatal. In 2012, nearly 800 people
in Germany for example came down with the infection, of whom 502
died.
When antibiotic treatment is ineffective, a natural mix of
intestinal bacteria has been shown to work wonders. In the Dutch
study, some of the test persons received an antibiotic and the others
an infusion of a relative's faeces.
The results were striking. While just four of 13 test persons were
cured with the antibiotic, the ratio was 13 of 16 with the stool
transplant. Symptoms such as abdominal cramps and belching
disappeared within a few hours.
The procedure is new and has been tested at only a few medical
centres and on few patients, said the Association of German
Gastroenterologists in Private Practice. It has been tried only a few
times in Germany, for example in Heidelberg and Ulm, in "expanded
access" programmes.
It has not yet been tried at Frankfurt University Hospital, but
Volkhard Kempf, director of the hospital's Institute for Medical
Microbiology and Infection Control, said he was convinced of "the
beneficial effects of donor stool: The useful bacteria that it
contains check the spread of the insidious germ and its infusion
normalises intestinal flora."
The "yuck" factor, as Kempf calls it, is a problem with faecal
therapy, though. "After all, the idea isn't especially savoury," he
said, adding that he could understand people's reservations.
In a stool transplant, between 100 and 200 grams of a donor's
faeces are diluted with about 50 millilitres of saline solution. The
solution can be infused into the large intestine through the anus
with a colonoscope, or into the small intestine with a nasogastric
tube.
Kempf said the unpleasant smell would concern him less than the
fact that donor faeces could transmit diseases.
Galle, too, pointed to the risk. "Stool contains a complex mix of
the most varied of bacteria," he said. "And it's virtually impossible
to distinguish between the good and bad ones."
Internet: http://dx.doi.org/10.1056/NEJMoa1205037
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