Fecal therapy: unappetizing, but effective
As a rule, about 15 years pass from the moment of confirmation of the safety and effectiveness of a new method of therapy to its widespread introduction into clinical practice. However, one somewhat unusual therapeutic approach, rapidly gaining adherents among both doctors and patients, turned this dogma upside down. We are talking about the transplantation of fecal microflora, which is currently actively used for the treatment of persistent intestinal infection caused by the microorganism Clostridium difficile, as well as tested as a method of treating Crohn's disease and ulcerative colitis.
C. difficile, as a rule, affects people whose normal intestinal microflora is weakened for some reason. Most often this happens after long courses of strong antibacterial drugs. The infection is manifested by persistent, in some cases life-threatening diarrhea of patients. Due to the recent appearance of a highly virulent strain of the pathogen, the US Center for Disease Prevention and Control has recognized this disease as a "global threat to public health."
In theory, a fecal microflora transplant should ensure the colonization of the affected intestine with a mixture of microorganisms that will displace pathogenic bacteria and form a new normal microflora. However, until now, in the absence of convincing scientific evidence, doctors have performed this procedure at their own risk out of a desire to help suffering patients.
A gastroenterologist from Harborview Medical Center, Dr. Susanna Surawicz, who is considered one of the pioneers in this field, notes that over 30 years of practice, most patients told her "You saved my life!" in gratitude for the use of fecal microflora transplantation. She first used this procedure in 2004 as a "despair therapy" to save a patient who had been suffering from persistent life-threatening diarrhea for 9 months.
According to doctors, very often the first reaction of patients to the proposal to apply this method of treatment is bewilderment and disgust. However, the continued suffering for many months and the lack of relief from traditional methods force them to change their minds.
As a rule, the donor is someone from close family members. There are no uniform recommendations for the examination of the donor, as well as methods for preparing the introduction of the material, and each medical center is guided by its own protocols. Some doctors inject donor feces into the upper parts of the digestive tract through a tube inserted into the patient's nose, others prefer the introduction "from below". The dose of the injected material also varies significantly.
Some clinics refuse to carry out such procedures, but the attending physicians recommend that patients do it at home on their own with a syringe. Although the latter method is very far from perfect.
Back in the early summer of this year, the US Food and Drug Administration (FDA) unequivocally declared feces a "biological drug" and warned doctors that in order to use it, they must obtain permission to work with a "new experimental drug."
However, the doctors insisted on their own. They complained that the need for a complex research process would increase the cost of treatment and restrict access to seriously ill patients. Moreover, this may push patients to self-fecal transplantation, which in itself is unsafe, at least due to the lack of examination of the donor.
Under such pressure, two months later, the agency relented and officially allowed doctors to transplant fecal microflora to patients with recurrent intestinal infection caused by clostridium. At the current stage, doctors can experiment with the procedure if one condition is met: patients should be warned that the therapy is experimental and potentially risky.
At the same time, the Seattle Children's Clinic recently completed an FDA-approved clinical trial of fecal transplantation for children with inflammatory bowel diseases. According to the head of the study, Dr. David Suskind, there were practically no improvements in patients with ulcerative colitis, while 7 out of 10 patients with Crohn's disease went into remission. This is comparable to the results obtained as a result of drug therapy, potentially having more undesirable side effects.
Despite all the successes of fecal therapy, experts urge caution. They note that there is still a lot of unknown in this area, in addition, optimal methods of carrying out the procedure have not been worked out. Moreover, they express concern about the appearance of websites on the Internet containing instructions for self-performing fecal transplantation.
However, in general, fecal therapy is gaining more and more respect in the research community. Canada is even developing a drug called "RePOOPulate" (from the English "repopulate" – to repopulate and "poop" – poop), which is an artificial mixture of fecal microorganisms and fecal pills – gelatin capsules filled with donor fecal bacteria.
The Robogut bioreactor developed at the Courtesy University of Guelph (University of Guelph in Ontario, Canada),
simulates the conditions of the human intestine that are optimal for obtaining a culture of fecal bacteria.Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru based on Medical Xpress materials:
Wonder cure for gut: FDA allows fecal transplants.
05.11.2013