Fecal Microbiota Tranplants

Q&A with Dr. Stacy Kahn

In tonight's Scientific Chicago, Ash-har Quraishi tells us about an unusual procedure called Fecal Microbiota Transplants.

Chicago Tonight spoke with Dr. Stacy Kahn, who specializes in the treatment of digestive diseases at the University of Chicago Medicine Comer Children's Hospital, about the procedure. Read our Q&A below.

What is Clostridium difficile, or C. Diff.?

C. Diff. is a type of bacteria. There are strains of bacteria that produce toxins, which are toxogenic. These are the kind that cause infection in people. There are also many kinds that are non-toxogenic that many people carry around and don’t bother us. C. Diff. is toxogenic and causes us to show symptoms. The range of symptoms is quite wide. It can seem like a normal gastrointestinal flu, where you’ll have abdominal cramps, diarrhea, gas and nausea. Most viruses are acute in onset, and identifying the trigger – say raw fish or another bad meal – is obvious. When you have a virus, you also get better quickly; not so with C. Diff. C. Diff. doesn’t stop. It actually progresses, and its presentations can be quite dramatic. In more serious cases, there’s frequent diarrhea, colitis (inflammation of the large intestine), mucus can be shed and fecal matter can become bloody.

What is a Fecal Microbiota Transplant, and how is it used to treat C. Diff.?

When you think about bacteria, people often know that foods have some healthy bacteria called probiotics. Yogurt is probably the most well-known of these types of foods. If there’s a disruption of a healthy balance of bacteria, you need to balance it once more by adding more of the healthy type of bacteria. This is what the Fecal Microbiota Transplant accomplishes.

Stool from a donor, which is basically a collection of probiotics, is delivered to the patient in order to restore bacterial balance. It can be delivered as an enema, a spray colonoscopy where the bacteria is delivered with a scope, or from above through a nasogastric tube or scope. It’s a targeted treatment where the bacteria are deposited directly into the digestive tract with the hope that it will restore a normal balance of healthy bacteria.

How quickly does the patient improve and how successful has the treatment been?

We consider the treatment successful when the patient returns to baseline health. As long as the patient shows no symptoms, they are considered cured. It’s remarkable. With most cases, symptoms stop with 24-48 hours. Even in some of the severe cases we’ve heard about, patients with significant infection, it’s been reported that there’s almost universal success within 24-48 hours. Even mild cases, like the case I encountered with Grant Fisher, got better in 24 hours. It’s not a controlled study, but he was back within 24 hours. His mom told me, “He’s back.” Parents can sense when their kids are healthy again.

We’ve found that using FMT to treat a recurring C. Diff. infection had a primary, meaning first-treatment cure rate of 91 percent. For those that continued showing symptoms and required a second transplant, the secondary cure rate was 98 percent.

How likely are patients to undergo a treatment that sounds so off-putting?

I’ve found that a majority of patients with inflammatory bowel disease, or Crohn’s disease, would be willing to undergo the treatment, even without knowing whether or not it works, because when you’re sick or a loved one is sick, the rules change. When you or someone you love has Crohn’s or C. Diff., which are significant diseases, you’re willing to think outside the box. There is no treatment without its flaws, but FMT is a very viable option to treat C. Diff. at this time.

Interview has been condensed and edited.

Read a study about FMT and its use as a treatment for C. Diff. in the pdf below.