Fecal Transplant

Yes, ‘fecal transplant’ sounds gross, but Mary Greeley’s innovative approach is providing fast, effective relief to patients who need it.

Intestinally speaking, Mary felt rotten.

She suspected that the antibiotics prescribed for a skin condition had caused her ulcerative colitis to flare up. Her doctor prescribed other antibiotics to treat the colitis, but they brought little relief. It was then this mother of two started thinking she might have something more serious.

She did.

Mary tested positive for C. diff, a nasty bacteria that wreaks all sorts of havoc in the bowel. A cycle of medications took care of the problem, but only temporarily. A few months later, Mary felt lousy again. Tests confirmed that the C. diff had returned. But this time, Mary, who requested that her real name not be used, learned about an alternative treatment with an initially disturbing name: fecal transplant.

It sounds gross, but as Mary and so many other patients at Mary Greeley Medical Center have found, this treatment is some kind of miracle.

A ‘Bowelful’ of Bacteria

There are literally trillions of bacteria in your bowel. Most of them are good, but some are bad and among the baddest is Clostridium difficile, or C. diff. Good bacteria can usually keep C. diff from growing uncontrollably in the bowel. People whose immune systems are compromised because of age, frailty or illness can be susceptible to C. diff. This is why the condition often affects people who are hospitalized or in care facilities.

C. diff can cause watery diarrhea that can be frequent and severe. It can lead to severe dilation of the colon known as toxic megacolon, which, in turn, can lead to a bowel rupture and death. According to the Centers for Disease Control, C. diff cases are on the rise in the United States.

There are three antibiotics that are typically used to treat C. diff. These antibiotics, which can be expensive, are effective in killing off C. diff. However, when killing the bad bacteria, they also can kill off the good. With a shortage of good bacteria, bad bacteria can easily re-establish itself in the bowel, inviting a C. diff relapse. Roughly 20 percent of patients treated for C. diff will have recurrences.

Under U.S. Food and Drug Administration regulations, fecal transplant can be used to treat recurrences of C. diff. At Mary Greeley, a highly effective and cost-efficient treatment has been in use for almost a year.

Mary Greeley’s innovative approach to the treatment was developed by McFarland Clinic’s Dr. Bryan Graveline, a gastroenterologist, Dr. Ricardo Arbulu, an infectious disease specialist, and Dr. Trisha Schlick, a McFarland Clinic pathologist. They developed protocols and processes for the treatment working with Sherri Olson, who heads up the microbiology section of Mary Greeley’s laboratory.

Donor Search

Fecal transplant involves administering a dose of healthy bacteria into a C. diff-infested bowel. Where do the healthy bacteria come from? They come from the stool sample of a, um, poop donor. Consider it the ultimate act of recycling.

Finding a healthy donor can take time and cost thousands of dollars because of the testing involved.

“Anybody can donate, but they need to be screened for common infectious diseases such as HIV, Hepatitis A, Hepatitis B and even C. diff, itself, as some people can be carriers without having any symptoms,” Graveline says.

Frozen samples await
fecal transplant procedures.

Graveline and Arbulu wondered if it would be possible to find a single donor whose healthy stool could be collected on a regular basis, processed, frozen and then used as needed. It would make the process less costly, and, because there would always be a supply of transplant material, provide more immediate relief for a C. diff sufferer.

They didn’t know if this method was a viable option, but with help from Mary Greeley’s medical librarian, the doctors found a research paper from Sweden that indicated it could work.

The next step was finding volunteers willing to donate their stools for testing. The doctors started their donor search with the simplest of strategies: Word of mouth. After asking around, they recruited several willing volunteers. They found a healthy donor and began collecting weekly donations, processing and freezing them.

Mary Greeley could be one of the few hospitals in the country doing this. Last year, Graveline attended a gastroenterology conference in Orlando, Fla. At one session, attended by thousands of healthcare professionals, a Harvard professor talked about how one day hospitals would collect stool samples from a healthy donor, freeze them and then use them as needed.

“I listened to this and thought, ‘Wow, we’ve been doing this at Mary Greeley for months,’” Graveline says. “I spoke to the speaker afterwards and he indicated that we may be the first or among the first hospitals to be doing this.”

90 Percent Success

Some of the equipment used in
sample processing.
Yes, a blender is involved.

Donated stool samples go through a clarifying process, which involves liquefying and straining, Olson says. The result is a thin, brownish liquid loaded with healthy bacteria, which is stored in freezers at Mary Greeley until it is needed to treat a patient. The material is usually administered through an enema, but can, if necessary, be given during a colonoscopy.

“The donor poop has trillions of fresh, healthy bacteria which immediately set up new homes in the colon and basically push out the bad C. diff,” Graveline says. “All of this action takes only a day or two to work, resulting in a rapid resolution of the diarrhea.”

Doctors in gastroenterology and infectious diseases have performed nearly 20 fecal transplants at Mary Greeley, with a 90 percent success rate. A few patients have had relapses due to the fact they were taking antibiotics for other conditions, which killed the healthy bacteria in their bowels.

After the return of her C. diff was confirmed, Dr. Jeremy Fields, a McFarland Clinic gastroenterologist, suggested that Mary try the new treatment Graveline and Arbulu were providing.

“I was not really crazy about the idea the first time I heard about it,” she says.

After doing her own research and having more discussion with Graveline, Mary opted to try fecal transplant.

“The results are what did it for me,” she says. “C. diff makes you feel weak all over. You just feel real down and yucky. I would tire easily and go to bed early. Now, I feel more normal than I have in a long time.”

Graveline and Arbulu have found that despite the “ick” factor, patients are receptive to the idea of fecal transplant.

“I’ve never encountered anyone who is seriously grossed out. People may joke and make all sorts of remarks, but they really want to try it because they’ve been through C. diff and don’t want to go through it again,” Arbulu says. “We are offering them something we know works and is easy to do.”