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Fecal Transplants

January 9, 2015

Let’s kick off the new year with a bang – by talking about the wildly successful medical procedure known as fecal microbiota transplantation… or poo poo transplant.

It’s not an Urban Dictionary term, it’s a real thing. In fact, it has an almost perfect success rate when treating Clostridium difficile infections. That’s big news because not only have C. diff cases tripled over the last decade, but the emergence of a hypervirulent strain makes it more difficult to treat. In just the United States, C. diff infects an estimated 3 million and kills ~100K annually.

It’s a nasty infection that causes inflammation in the colon and potentially life threatening diarrhea. Even worse, it’s prone to recurrence – so many patients will suffer from it again and again. Usually it’s treated with vancomycin, an antibiotic that only cures it about 30% of the time. However, the Mayo Clinic reports that simple and cheap fecal transplants have 90% cure rate with only a SINGLE treatment. Amazing.

So how the heck does putting someone else’s goodies up your tushy cure such a nasty illness? Doctors believe that your healthy gut bacteria normally protect you from invading pathogens like C. difficile. However, antibiotics taken for other infections can kill the healthy gut bacteria and allow bad guys to take hold. By overwhelming the system with someone else’s healthy bacteria, the normal balance is restored and the infection can be cured permanently. Ta-da!

Yay poop!

So what exactly does a fecal transplant involve? Well typically you have to ask a really close friend or spouse to do you a solid (lol) and poop in a bag. The doctor infuses the stool with saline, runs it over a filter to remove solid particles, and then uses the bacteria-rich poo broth to give you the best cleanse you’ve ever had. It’s most commonly administered via enema, but it can also be delivered through a colonoscope or through a tube snaked up your nose and through your stomach.

If these routes are freaking you out, just be glad you didn’t live in ancient China. Reports of fecal transplants exist from way back then, only then they mixed poop and water and made you drink it. It was called “yellow soup,” and I like to imagine it came with a complimentary dose of opium.

The Pu-Pu platter has come a long way

Although this shit is effective its use is still controversial because safety regulations are lacking. Donors are screened for pathogens before harvest, but we aren’t quite sure what is transmissible via fecal transplant. We also aren’t sure what works best for harvesting and liquifying the donor stool. For example… blenders are commonly used, but they might reduce the therapeutic poo-tential by introducing too much oxygen and killing beneficial anaerobic bacteria.

The FDA has classified human feces as an experimental drug (so congrats, you’re all drug mules now), bringing us one step closer to using this method as a first line treatment. There’s evidence that it may also benefit patients with irritable bowel syndrome, colitis, and other neurological diseases. Hopefully once we learn more about the safety and long term effects of fecal transplants, more doctors and patients will get over the ick factor and be down with the brown.

So there ya have it – poop can save lives.


From → Biology

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