Everyone has an ick quotient, and it varies from person to person. Mine was tested recently while watching a cooking show in which an elegant Italian woman prepared a delicious-looking meal featuring … rabbit. My ick quotient has so far stopped me short of eating rabbit, but Lorenza certainly made it look appealing. And if I suffered from chronic Clostridium difficile infections, and she told me that eating Thumper would clear it up in a day, I might well give it a try.
More patients with chronic C. difficile might have the option to put their ick quotients to the test and consider fecal implantation, if more physicians and health care providers are willing to push the limits of their own ick quotients and perform the procedure.
During a press briefing at the annual meeting of the American College of Gastroenterology, Dr. Lawrence J. Brandt of Albert Einstein College of Medicine in New York, said the procedure has become so commonplace that his nurses have become inured to it, and no longer have to draw straws when a patient arrives for fecal implantation. He is getting about 3 calls a week with inquiries about it, he added.
Fecal transplant is exactly what it sounds like: taking the fecal contents from a healthy person and transplanting it into a C.difficile patient — via delivery methods that include nasogastric tube, enema, and oral capsules — to get rid of the C.diff and restore the sick person’s healthy gut bacteria. That sounds revolting to many people, including doctors and health care workers. But according to Dr. Brandt, the implantation is safe, easy, and inexpensive. And the limited patient data show a cure rate of nearly 100%, with patients reporting that they feel better as soon as the next day.
Dr. Brandt said that his first choice for a fecal transplant donor is an “intimate contact.” (I doubt this crosses the mind of many couples during the “in sickness and in health” part of the wedding vows.) He also has had donors who are siblings, nonrelated household contacts, and friends.
Stay tuned: Although the largest reported case series numbers fewer than 20 patients, Dr. Brandt said that perhaps clinicians should consider fecal transplant as therapy for chronic C. difficile. If they can get over the ick factor, that is.
–Heidi Splete (on twitter @hsplete)