Don’t pinch your nose. A healthy stool transplant or what is known as Fecal Microbiota Transplant (FMT), can save lives.
Severe liver disease due to alcohol is on the rise and recently the scientists at Institute of Liver and Biliary Sciences (ILBS), New Delhi have shown beneficial results in a study using stool transplant to treat severe alcoholic hepatitis.
Pre-screened, healthy stool from a relative was used for the patients. This, however, is not the first or only indication for FMT.
What is Fecal Microbiota Transplant
Fecal Microbiota Transplant (FMT) is a procedure in which fecal matter, or stool, is collected from a donor and tested for absence of several communicable diseases. This is then mixed with saline or other appropriate solution, strained, and placed in a patient with the help of tubes or through other vehicles like colonoscopy, gastroscopy, or enema.
The purpose of fecal transplant is to re-establish good bacteria that have been killed or suppressed – usually by the overuse of antibiotics – causing bad bacteria to flourish in the large intestine, thereby compromising the gut immunity.
This infection called Clostridium difficille infection, causes a condition called pseudomembranous colitis, resulting in often severely debilitating, sometimes fatal bloody diarrhoea.
Logic Behind Using Stool as Treatment
It may come as a surprise to many that bacteria form most of the stool weight. These bacteria are by and large good bacteria in a healthy individual, which have been shown to be responsible greatly for maintaining the intestinal immunity.
This massive reserve of bacteria helps modulate gut microbiota in patients suffering from various diseases. The new species from the donor – which are usually beneficial – coexist with pre-existing bacterial population of the recipient and the latter gets substantially modified by the donor species.
Roots in Ancient Traditions
The Chinese used fecal transplant as early as in 4th century calling it “yellow soup”. It has been used for 100 years in veterinary medicine. Even in humans, it is being used regularly in many countries as the first line treatment of antibiotic associated Clostridium difficile (C diff) colitis, for several years.
Howsoever it may hurt one’s aesthetic sensibilities, it may be interesting to note that it is customary in many areas of the world for a newborn to be given a drop or two of the mother’s stool by mouth, thought to provide immediate establishment of good bacteria in the newborn’s large intestine, thereby jacking up the baby’s immune system.
FMT has been used in the US, sporadically since the 1950s, without much regulation. It has gained popularity recently, although in India the estimated total number of treatments to date still is a few hundreds only, as it is still classified as an experimental treatment. But fecal transplant is proving to be a low-cost, low-risk, highly-effective treatment.
Fecal transplant has also shown promising results with many other digestive diseases, including Irritable Bowel Syndrome, Crohn’s Disease, and Ulcerative Colitis. It has also been used around the world to treat other conditions, although more research in other areas is needed.
In all the available documentation dating back to 4th century China, there has never been a single, serious side-effect reported from fecal transplant.
(Dr Ashwini Setya is a Gastroenterologist and Programme Director in Delhi’s Max Super Speciality Hospital. He can be reached at firstname.lastname@example.org. )