No butts about it — fecal transplants work for some

By JoNel Aleccia

Before she got so sick with a Clostridium difficile infection, Vicki Doriott would have been as disgusted as anyone at the idea of a fecal transplant.

Infuse her gut with someone else’s stool? Through a tube in her nose? No, thanks.

But in June 2004, Doriott was actually relieved to show up at a Duluth, Minn., clinic, where doctors sent samples of her husband's excrement sliding into her stomach – and apparently cured the infection that threatened to ruin her life. 

“When those toxins are in your body, you kind of feel like you’re close to death,” said Doriott, 52, an accountant from Eau Claire, Wis., who spent nearly six months battling recurrent bouts of the nasty intestinal bug known as C. diff.  “Nothing else I tried worked.”

Doriott is among a growing number of people who’ve undergone the seemingly gross procedure in a  last ditch effort to restore normal bowel function after severe, recurrent C. diff infection. The little-known technique gained new fame last month when an episode of “Grey’s Anatomy” highlighted the quirky cure that helps 85 percent of those willing to try it.

By coincidence, the specialist who performs most of the fecal transplants in the nation, Dr. Tim Rubin of theDuluth Clinic Digestive Health Center, happened to be channel-surfing at the time. Rubin gave the TV docs a thumbs up in handling the procedure.

“They did very well,” said Rubin, a gastroenterologist.

About the only thing the docs at Seattle Grace got wrong was the method of the preparing the fresh, donated stool that repopulates the gut of C. diff infection sufferers with healthy bacteria. 

“They showed a doctor stirring up a bowl of brown stuff at the bedside and that’s not how it’s done,” said Rubin.

And he should know. As far as Rubin can tell, he and his senior colleagues are the only crew in the country who regularly perform the rare, but growing procedure, variously known as fecal transplant, stool transplant and fecal infusion. 

Since 2002, they’ve performed 64 poop transfers on patients with two or more incurable bouts of C. diff. It’s a technique first documented in the early 1990s by researchers in Norway investigating the best way to treat C. diff infection, which typically occurs when the normal flora in the gut is disturbed, most often by antibiotic use.

Rates of C. diff are skyrocketing in the U.S., where a recent study found 13 of every 1,000 patients in the nation’s hospitals are infected or colonized with the germ.

The antibiotics destroy good bacteria in the colon, allowing the C. diff to flourish. The bug can cause illnesses ranging from severe diarrhea and colitis to blood infection, and in worst cases, death. Most patients with C. diff can control it with powerful antibiotics such as metronidazole, sold as Flagyl, or vancomycin. But in about 20 percent of the cases, even those strong drugs don’t work.

That was the case for Doriott, who figures C. diff spores in her gut were activated when she had two rounds of antibiotics for a sinus infection and dental work within six months. 

“At its worst, I’d have diarrhea every 15 minutes,” recalled Doriott. “I’d be going for two or three days. I’d have a 103-degree fever. I couldn’t make it two steps from the couch.”

After months of exhaustion and illness, Doriott became desperate enough to consider the fecal transplants she’d heard about through research. She contacted Rubin in Duluth and made an appointment for the hour-long office visit.

Typically, patients ask a close household member, usually a spouse, to produce a sample of stool, which is tested for disease and infection. In Doriott's case, her husband, Jerry, 50, a civil engineer, was on tap.

On the day of the transplant, donors provide the feces, which is blended and filtered. A tube is fed through the patient’s nose into the stomach and several teaspoons of the sample are injected through it.

“I refused to look at it,” said Doriott. “All I felt was a coolness. It didn’t smell.”

Doriott said she felt better immediately and hasn’t suffered a C. diff relapse since the treatment. Other patients take a few weeks or even months to recover, Rubin said.

A 2003 case study of 18 patients who received fecal transplants found that two patients who were very ill died shortly after transplant. But of the remaining 16 patients, only one developed C. diff again, according to the study published in the Journal of Clinical Infectious Diseases.

Still, fecal transplant has yet to become a widespread treatment, Rubin said.

“You’re going to go to some places and they’re going to, no pun intended, pooh-pooh it,” he said.

Some scientists worry about controlling infection in donor stools and about finding a good way to handle and process the material, said Jennie Mayfield, a clinical epidemiologist at Barnes-Jewish Hospital at the Washington University School of Medicine in St. Louis, Mo.
And some doctors and patients are still squeamish about the procedure.

“It think it’s the kind of thing in the U.S. where people are talking about it, but people don’t want to go there yet,” Mayfield said. “They’d have to give me Valium.”

But Rubin and Doriott agreed that by the time patients are ill enough with C. diff to consider fecal transplants, neither the ick effect nor the potential for bad puns is a factor.

Dorriott, meantime, has managed to put the event behind her. “My husband doesn’t joke too much,” she said, “because he saw how sick I was.”