Fecal transplants are gaining ground as a highly effective treatment for recurrent infection with the intestinal bacteria clostridium difficile. But the "yuck factor" of the procedure continues to deter physicians from offering it to patients who could benefit, said a practicing gastroenterologist, who has come up with a solution to the problem: a gelatin capsule filled with the highly compacted fecal matter of a patient's family member.
"There is no smell. We basically have a little cubette of microbes and we pour it into the capsules," said Dr. Thomas Louie of the University of Calgary in Alberta, Canada. Louie said that so far, he had treated 32 patients with a regimen of fecal transplant pills, and all but one had suffered no recurrence of the stubborn and painful intestinal infection.
Louie reported on his innovation at the ID week meeting of infectious disease researchers and clinicians in San Francisco this week. His report came against the backdrop of rising incidence of the infection, largely among the hospitalized elderly and those with chronic diseases, as well patients who take antibiotics.
As many as 500,000 patients a year in the United States suffer from chronic c difficile infection, and about 14,000 a year die of it.
Since 1996, Louie said he had performed fecal transplants by enema in his office as a treatment for recurrent c difficile. But in 2010, "a light dawned on me: I would turn it into pills," he said.
To do so, Louie would continue to solicit stool from a donor related to the patient and to subject that donor to a rigorous battery of tests ensuring against the transfer of blood-borne diseases or pathogens. But instead of turning that stool into a slurry, and then shooting it into a patient's rectum, he would filter the bulky undigested food from the mix, distill the remaining community of bacteria, and compact it by applying pressure as high as 10,000 times the force of gravity to the mix.
The resulting solids can then be poured into a gelatin tablet designed to dissolve slowly in a patient's gut and begin to release its contents in the lower small bowel about an hour after they are taken. Louie initially gave the pills to patients over four days, at roughly 10 pills a day. But as refined his treatment protocol, he said patients had responded well to a single day of treatment, in which they swallow "a couple of dozen" pills on an empty stomach "and then go home and have lunch."
As the capsule's contents begin to establish themselves in the bowels of patients, who have often struggled with diarrhea and intestinal cramping for months, "the normal, good bacterial outcompete the c difficile," Louie said. "We've sort of reestablished diversity in the bowels, so there’ll be thousands of bacteria in the gut, and that keeps c dif under control."
Louie said he had had "many requests" to disseminate the process he used, adding that had been "entirely open about it."
As for the yuck factor that hangs over the highly effective treatment for recurrent c dificile infection, Louie called it "something we got from the schoolyard when we were 4 or 5." But, he added, "we need to get over it."