Other people’s poop can save lives
Donor stools can cure seriously ill patients.
Nine out of ten patients with the bowel disease Clostridium difficile can be cured after one or more faecal transplants.
This treatment with other people’s poop is now being systemised.
Every year, more than 3,500 Danish patients become affected by the dangerous intestinal bacterium Clostridioides difficile. These are a stubborn bacteria which can cause diarrhoea and severe intestinal inflammation. These bacteria are especially dangerous to the weak, the elderly and chronically ill patients undergoing antibiotic treatment.
Frequent courses of antibiotics can interfere with intestinal balance causing the good intestinal bacteria to become outnumbered or to disappear altogether and letting Clostridioides difficile get the upper hand. This can become dangerous to the patient and the diarrhoea can develop into a life-threatening infection that could cause the patient to lose his or her life.
Faecal transplant therapy
After many studies and several attempts at curing patients with Clostridioides difficile using bacterial cultures, the breakthrough happened in 2013 in Europe.
A Dutch endocrinologist documented that faecal transplant therapy – also known as faecal microbiota transplant (FMT) – could cure nine out of ten patients of Clostridioides difficile. The method involves transferring good intestinal bacteria from a donor to a patient.
– The effect of faecal transplant therapy is significantly better than that of the best antibiotics available which cure only two out of ten, says Christian Lodberg Hvas.
He is a Chief Consultant at the Department of Hepatology and Gastroenterology, Aarhus University Hospital, and a Clinical Lecturer at the Department of Clinical Medicine, Aarhus University, and he recommends that faecal transplant therapy should be the first choice for patients experiencing a recurrence of these stubborn bacteria after a course of antibiotics.
17 million for the development of a Danish standard treatment
Today, faecal transplant therapy is performed at several Danish hospitals as part of research projects and, in 2018, Christian Lodberg Hvas and his research team received a grant of DKK 17 million from Innovation Fund Denmark.
The money is earmarked for the work of turning stools from healthy, registered and tested donors into a Danish standard treatment. The research team is also in the process of identifying suitable stool donors and building up a stool bank.
– Faecal transplant therapy not only saves the life of the individual patient – it is also a good investment for the hospital system and, thus, for society, says Christian Lodberg Hvas.
After reviewing the initial treatments, he found significant savings over previous treatments which typically caused the patients to be hospitalised multiple times and for extended periods.
A diverse bacterial composition is the key to good health
Experts believe that the key to good health is having many different intestinal bacteria – in other words, great diversity is important.
A number of studies also confirm that there is a link between a poor microbiota (intestinal flora) – a microbiota with only a few types of bacteria – and serious diseases such as chronic bowel inflammation (Colitis Ulcerosa), disseminated sclerosis, Parkinson’s, Alzheimer’s and colon cancer.
This also applies to diseases such as autism, allergies and type 2 diabetes.
Some researchers believe that many of these serious diseases may be cured using faecal transplant therapy and, at the time of writing, there are approximately 200 studies into whether this is the case.
This is how faecal transplant therapy is performed
Faecal transplant therapy (FMT) may be performed in three ways, about equally effective:
- Through colonic endoscopy where the endoscope is inserted into the colon
- Through a stomach tube to the small intestine where the probe is passed through one nostril
- By way of capsules (a total of about 30) which are to be swallowed
Contested classification: Medicine or tissue?
The possibility of, in the long term, being able to cure other serious diseases using intestinal bacteria has also received the attention of the pharmaceutical industry. They see a business idea in donor faecal transplant therapy. For this reason, they are interested in having faeces classified as a medicine – and hospitals are not permitted to manufacture medicine. Medical practitioners, on the other hand, believe that this is a matter of using tissue on a par with blood and bone marrow. They would, therefore, prefer to have faeces classified as tissue.
At the Aarhus University Hospital, there is no need to wait for a decision. The Danish Patient Safety Authority has given the green light to continuing the work of building a faeces bank and treating seriously ill patients using faecal transplant therapy.
By Christa Zenobie Dahl
Aarhus University Hospital, Department of Hepatology and Gastroenterology, Patient guidelines: General guidelines on faecal transplant therapy (“Generel vejledning om fæcestransplantation”).
Article in ING.dk/Ingeniøren – ing.dk, 14 Maj 2016: ”Vital aides – and new way to treatment and prevention: Bacteria control your life” (“Livsvigtige hjælpere – og ny vej til behandling og forebyggelse: Bakterierne styrer dit liv”) by Mie Stage.
Article in the newspaper Weekendavisen, 1 November 2019: “The brown gold” (”Det brune guld”) by Gunver Lystbæk
Article on the scientific forum Forskerzonen, 3 September 2019 at Videnskab.dk: “Can miracle poop cure more than one life-threatening disease?” (”Kan mirakellort helbrede mere end én livstruende sygdom?”) by Christian Lodberg Hvas – Chief Consultant at the Department of Hepatology and Gastroenterology, Aarhus University Hospital and Clinical Lecturer at Department of Clinical Medicine, Aarhus University, and Lars Holger Ehlers – Professor of Health Economics at the Department of Clinical Medicine, Aalborg University.