Wetenschap - 7 februari 2013

Faecal transplant in top journal

Transferring intestinal flora to diarrhoea patients has been a 'resounding success'.
The method is not used much because of 'yuck factor'.





Wageningen microbiologists get into top journals quite often. But a publication in a top medical journal is more unusual. This week, they and their Amsterdam medical colleagues explain in The New England Journal of Medicine how you can cure the most stubborn bowel infections. The secret? Faecal transplants.
The experiment revolved around a group of diarrhoea patients suffering from persistent bowel infections with the Clostridium difficile bacterium. Doctors usually treat this ailment by blitzing it - repeatedly - with antibiotics. But about 20 percent of the patients do not respond and every time the infection comes back, their chances of recovery diminish.
An alternative to antibiotics is the faecal transplant, an intervention in which patients are given new gut flora from a healthy donor. In more graphic terms: diluted faeces are pumped into their intestines (after colonic irrigation) via a nasal tube. This treatment has been in sporadic use for decades but has never really caught on - possibly because of the 'yuck factor'.  By 2011 there was still no verdict on it from the Cochrane collaboration, which assesses the evidence for the value of medical treatments.
However unappetizing the faecal transplant might sound, the test was a resounding success. Researchers compared three groups of patients who were healthy, apart from their diarrhoea. The first group took the usual antibiotics, the second was also put through colonic irrigation, and the last group received new gut flora after the antibiotics and the colonic irrigation.
Massive
In the two control groups, between 23 and 31 percent of the patients got better. But in the group that got the transplant, the diarrhoea disappeared in a massive 81 percent of cases. In the second round, this figure went up to 92 percent.
The differences were so big that the experiment was stopped halfway. With such big differences, it would be unethical to withhold the best treatment from two thirds of the patients. These patients were allowed the transplants as well.
In the microbiology department they were 'very pleased' with the publication and a bottle of champagne had already been uncorked in its honour, says Erwin Zoetendal, assistant professor of Microbiology. Their task was to identify the gut flora of patients and donors. 'In the patients you can see that their intestinal flora are totally disturbed,' explains Zoetendal. 'The composition is different and the diversity of bacteria is much lower. In the second round, after the transplant, they look much more like normal gut flora.'  
 

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