GI Docs Use Ancient Treatment for Modern Wave of Drug Resistant and Sometimes Fatal Clostridium Difficile; C. Diff.

A modification of a procedure that’s been around since the 4th century in ancient China is being used to cure the devastating and sometimes fatal Clostridium difficile infection. Also known as C. diff, this bacterium runs amok in the GI tract causing debilitating diarrhea that can last for years.

August 29, 2013

Fecal Transplants Cure Patients with Life-Threatening Diarrhea Within One to Two Days

(Washington, D.C.) – A modification of a procedure that’s been around since the 4th century in ancient China is being used to cure the devastating and sometimes fatal Clostridium difficile infection. Also known as C. diff, this bacterium runs amok in the GI tract causing debilitating diarrhea that can last for years.

Each year C. diff kills 14,000 people in the United States and affects as many as 336,000, according to the Centers for Disease Control and Prevention.

“Dangerous cases of C. diff are on the rise and we’re seeing it in younger and younger patients,” said Mark Mattar, MD, Gastroenterologist at MedStar Georgetown University Hospital. “We used to see it mainly in the elderly population of people in nursing homes or hospitals but now we’re seeing it in people who have taken antibiotics for everyday ailments like bronchitis or urinary tract infections.”

To treat C. difficile doctors often use antibiotics like Flagyl, or if that doesn’t work, they turn to the stronger vancomycin or even a pricier Dificid antibiotic.  But as its name “difficile” suggests, sometimes even the strongest bacteria killers don’t vanquish C. diff.

That’s when gastroenterologists like Dr. Mattar are trying something old and a little, well, gross and are getting success rates of over 90 percent.

“It’s not hi-tech or glamorous, but we’re transplanting feces from one person to another and within a day or two, their diarrhea is gone,” said Dr. Mattar.

How does it work?“There are trillions of bacteria in the gut, which starts at the mouth and ends at the anus,” explained Dr. Mattar. “Those bacteria live in a delicately balanced world where the flora have to exist in harmony for the GI tract to work properly.  When you take an antibiotic to kill an infection elsewhere in your body, unfortunately you also kill some healthy bacteria in your GI tract and upset that balance. That’s when C. difficile can invade and wreak havoc.”

Camilla Schlegel of Maryland came to see Dr. Mattar recently when her 92 year old mother’s case of C. diff had dragged on for more than 10 months and became life-threatening.  “It was very debilitating and very hard to manage and keep my mother clean,” said Camilla. “My mother was hospitalized for dehydration and various trials of antibiotics. She lost weight and was so weak that she could no longer push herself around in her wheel chair.”

After all else failed, Camilla came to see Dr. Mattar and became a fecal donor for her mother. “At first it sounded off the wall,” Camilla reflected. “But this procedure helped my mother like no other pharmaceutical method did. I was very amazed how quickly it worked. She was feeling better the same day.  She’s been able to eat and propel herself in her wheelchair.”

An intimate partner, housemate, or family member usually works the best for a fecal transplant, also known as fecal microbiota transplantation, or FMT, according to Dr. Mattar.

“I know people might feel squeamish about this procedure,” said Camilla. “But the oddness and inconvenience are minimal in comparison to watching someone you love be so ill and so contagious to others. And there were no side effects here. I call that an all-around win.”

“Our protocol at MedStar Georgetown is to first test the donor for C. diff, GI parasites and other infectious diseases with stool samples and blood tests,” said Dr. Mattar. “Once the donor is deemed appropriate, they’re sent home with a kit with specific instructions to collect and prepare the stool.”

When they return, Dr. Mattar uses colonoscopy to instill the donor feces into the GI tract of the recipient where the donor feces help to restore the normal flora to the GI tract.

“I wish we had done this transplant sooner. In addition to my mother being uncomfortable for so long, there were financial consequences. I had to spend my mother’s dwindling funds to hire extra nursing aides to keep her clean and comfortable. Plus the last medication we tried was $3500 per course and we did three courses.”

“And if the fecal transplant doesn’t work, we can try giving vancomycin again,” said Dr. Mattar. “Studies suggest that the fecal transplant often changes the GI flora enough to make C. difficile susceptible to vancomycin in up to 80 percent of people who were previously resistant to this.”

In Dr. Mattar’s capacity at MedStar Georgetown’s Inflammatory Bowel Disease (IBD) Center, he is also interested in the possible role of FMT to combat inflammatory bowel diseases like ulcerative colitis and Crohn’s disease. “We’re not there yet, but there are small trials revealing that such a shift in the gut microbiome makeup may be helpful in treating IBD. It is thought that IBD comes from an inappropriate immune response towards the gut bacteria. No specific bacterium has been found to be the culprit but it might be related to reduced diversity of these bacteria in patients with IBD. FMT helps bring back the healthy, diverse bacterial flora that can, in turn, decrease the frequency and severity of IBD flares. More studies are needed to establish the safety and efficacy of using FMT in IBD patients.”

“It’s exciting to take old medicine and apply it to the here and now. East meets West; a prime example of integrative medicine that is saving peoples’ lives,” said Dr. Mattar.

The Food and Drug Administration (FDA) has recently taken interest in somehow regulating the administration of FMT. After meetings with the American Gastroenterological Association (AGA) and other prominent organizations, it has been decided that this procedure may be performed for recurrent C. difficile infections when the physician deems it appropriate, with the proper documentation and consent from the patient. Dr. Mattar states, “I've taken it upon myself to keep communication with FDA representatives open about our protocol. The FDA continues to support our efforts as we collaborate with them as an academic center in providing the best care to our patients. We continue to perform these procedures with full support from the FDA.”

Elizabeth Phillips (left) now fully recovered from C. diff, a serious digestive disorder, enjoys a visit from her daughter, Camilla Phillips Schlegel, and Annie, who enjoys Elizabeth's hugs.
Elizabeth Phillips (left) now fully recovered from C. diff, a serious digestive disorder, enjoys a visit from her daughter, Camilla Phillips Schlegel, and Annie, who enjoys Elizabeth's hugs.

About MedStar Georgetown University Hospital

MedStar Georgetown University Hospital is a not-for-profit, acute-care teaching and research hospital with 609 beds located in Northwest Washington, D.C. Founded in the Jesuit principle of cura personalis—caring for the whole person—MedStar Georgetown is committed to offering a variety of innovative diagnostic and treatment options within a trusting and compassionate environment.

MedStar Georgetown’s centers of excellence include neurosciences, transplant, cancer and gastroenterology. Along with Magnet® nurses, internationally recognized physicians, advanced research and cutting-edge technologies, MedStar Georgetown’s healthcare professionals have a reputation for medical excellence and leadership. MedStar Georgetown University Hospital—Knowledge and Compassion Focused on You.

About MedStar Health

MedStar Health combines the best aspects of academic medicine, research and innovation with a complete spectrum of clinical services to advance patient care. As the largest healthcare provider in Maryland and the Washington, D.C., region, MedStar’s 10 hospitals, the MedStar Health Research Institute and a comprehensive scope of health-related organizations are recognized regionally and nationally for excellence in medical care. MedStar has one of the largest graduate medical education programs in the country, training more than 1,100 medical residents annually, and is the medical education and clinical partner of Georgetown University. MedStar Health is a $4.5 billion not-for-profit, regional healthcare system based in Columbia, Maryland, and one of the largest employers in the region. Its almost 30,000 associates and 6,000 affiliated physicians all support MedStar Health’s Patient First philosophy that combines care, compassion and clinical excellence with an emphasis on customer service.

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