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http://www.bbc.co.uk/portuguese/noticias/2011/12/111212_transplante_fecal_c_difficile_rw.shtml
Portuguese-English translation
Fecal transplant physicians advocate against superbug
Updated December 12, 2011 - 10:16 (GMT) 12:16 GMT
The superbug Clostridium difficile reproduce without competition from other bacteria
The idea can turn the stomach of many people, but the stool transplant from one person to another can help save lives.
Some doctors are using the procedure to help repopulate the intestines with beneficial bacteria, which may disappear after some illnesses.
These beneficial bacteria help combat gut infections like those caused by suberbact?ria Clostridium difficile , highly resistant to antibiotics.
Alisdair MacConnachie, believed to be the only doctor in Britain to do this type of transplant, says that treatment efficacy is proven, but it should be used only as a last resort.
The logic is simple. Infection with C.difficile can be caused by the use of antibiotics, which kill bacteria in the gut. This gives bacteria C.difficile space for survivors to reproduce widely and produce large amounts of toxins that can cause diarrhea and lead to death.
The most obvious solution, the intake of more antibiotics does not always work and some patients develop chronic infections.
The theory is that by adding more bacteria to the intestine, they will compete with C.difficile and control the infection.
Tube through the nose
MacConnachie of Gratnavel General Hospital, Glasgow, has conducted more than 20 such operations since 2003.
"Only one patient that I did not get rid of C.difficile , "he said.
If standard treatments do not work, patients receive antibiotics until the night before the operation, when the drugs are exchanged for others to control stomach acidity.
On the morning of the operation, the donor goes to the hospital and produces a sample.
Typically, a relative is used, preferably someone who lives with the patient, because living in the same environment and eating the same food means it's more likely that they have similar intestinal bacterial flora.
About 30 grams of fecal matter is taken and mixed in a blender with a little salt water. This is then filtered to leave only a liquid.
MacConnachie inserts a tube through the nose into your stomach pacidente. Other doctors use different paths to reach the intestine.
About 30 milliliters of fluid are then inserted through the tube.
Prejudice
" It looks disgusting, it's disgusting, and I think people probably are afraid to reach out to patients and discuss the matter "
Alisdair MacConnachie, medical Gratnavel General Hospital, Glasgow
"My personal view is that this technique is there for patients who have tried all the traditional treatments," said MacConnachie.
"If a patient does not respond to that and have chronic infection with C.difficile , then you are in trouble and there's really no other technique or treatment with proven efficacy that has fecal transplantation "he says.
For him, the prejudice that prevents more people to benefit from treatment. "It is a published technical (scientific publications). I think people are afraid," he says.
"It looks disgusting, it's disgusting, and I think people probably are afraid to reach out to patients and discuss the matter," he says.
This is not a problem faced by Lawrence Brandt, a gastroenterologist at Montefiore Medical Center in New York.
He says he now receives between two and four e-mails daily from people who want to go through the transplant. So far he has done the operation in 42 patients.
He recalled his first operation in 1999: "The patient called me six hours after transplantation fecal and said he did not know what I had done there, but she felt better than she had felt in six months. And in fact She never had an infection with C.difficile , "he says.
Besides patients, he says there are more doctors expressing interest in the technique in the United States.
"Over the next six months or a year, this will be the most exciting thing that happened to gastroenterology. This will certainly change the way C.difficile and other diseases are treated well, "he says.
Irritable bowel syndrome, diarrhea and constipation are also on the list of possible applications. "This seems to be a great approach for a wide variety of diseases," he says.
Studies
The practice was reported in only a few case studies in combating recurrent infection with C.difficile .
There were a success rate of about 90%. That's not enough, however, that the technique is widely adopted.
The standard for determining whether a treatment works is a randomized clinical trial - take a large group of patients and give a part of the treatment in question and the other a placebo or different treatment. The two groups are then compared to see if the treatment really makes a difference.
Until the fecal transplant technique is analyzed in this way, it will be difficult to get a wide acceptance.
Portuguese-English translation
Fecal transplant physicians advocate against superbug
Updated December 12, 2011 - 10:16 (GMT) 12:16 GMT
The superbug Clostridium difficile reproduce without competition from other bacteria
The idea can turn the stomach of many people, but the stool transplant from one person to another can help save lives.
Some doctors are using the procedure to help repopulate the intestines with beneficial bacteria, which may disappear after some illnesses.
These beneficial bacteria help combat gut infections like those caused by suberbact?ria Clostridium difficile , highly resistant to antibiotics.
Alisdair MacConnachie, believed to be the only doctor in Britain to do this type of transplant, says that treatment efficacy is proven, but it should be used only as a last resort.
The logic is simple. Infection with C.difficile can be caused by the use of antibiotics, which kill bacteria in the gut. This gives bacteria C.difficile space for survivors to reproduce widely and produce large amounts of toxins that can cause diarrhea and lead to death.
The most obvious solution, the intake of more antibiotics does not always work and some patients develop chronic infections.
The theory is that by adding more bacteria to the intestine, they will compete with C.difficile and control the infection.
Tube through the nose
MacConnachie of Gratnavel General Hospital, Glasgow, has conducted more than 20 such operations since 2003.
"Only one patient that I did not get rid of C.difficile , "he said.
If standard treatments do not work, patients receive antibiotics until the night before the operation, when the drugs are exchanged for others to control stomach acidity.
On the morning of the operation, the donor goes to the hospital and produces a sample.
Typically, a relative is used, preferably someone who lives with the patient, because living in the same environment and eating the same food means it's more likely that they have similar intestinal bacterial flora.
About 30 grams of fecal matter is taken and mixed in a blender with a little salt water. This is then filtered to leave only a liquid.
MacConnachie inserts a tube through the nose into your stomach pacidente. Other doctors use different paths to reach the intestine.
About 30 milliliters of fluid are then inserted through the tube.
Prejudice
" It looks disgusting, it's disgusting, and I think people probably are afraid to reach out to patients and discuss the matter "
Alisdair MacConnachie, medical Gratnavel General Hospital, Glasgow
"My personal view is that this technique is there for patients who have tried all the traditional treatments," said MacConnachie.
"If a patient does not respond to that and have chronic infection with C.difficile , then you are in trouble and there's really no other technique or treatment with proven efficacy that has fecal transplantation "he says.
For him, the prejudice that prevents more people to benefit from treatment. "It is a published technical (scientific publications). I think people are afraid," he says.
"It looks disgusting, it's disgusting, and I think people probably are afraid to reach out to patients and discuss the matter," he says.
This is not a problem faced by Lawrence Brandt, a gastroenterologist at Montefiore Medical Center in New York.
He says he now receives between two and four e-mails daily from people who want to go through the transplant. So far he has done the operation in 42 patients.
He recalled his first operation in 1999: "The patient called me six hours after transplantation fecal and said he did not know what I had done there, but she felt better than she had felt in six months. And in fact She never had an infection with C.difficile , "he says.
Besides patients, he says there are more doctors expressing interest in the technique in the United States.
"Over the next six months or a year, this will be the most exciting thing that happened to gastroenterology. This will certainly change the way C.difficile and other diseases are treated well, "he says.
Irritable bowel syndrome, diarrhea and constipation are also on the list of possible applications. "This seems to be a great approach for a wide variety of diseases," he says.
Studies
The practice was reported in only a few case studies in combating recurrent infection with C.difficile .
There were a success rate of about 90%. That's not enough, however, that the technique is widely adopted.
The standard for determining whether a treatment works is a randomized clinical trial - take a large group of patients and give a part of the treatment in question and the other a placebo or different treatment. The two groups are then compared to see if the treatment really makes a difference.
Until the fecal transplant technique is analyzed in this way, it will be difficult to get a wide acceptance.