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Treatment powered by poop may cure deadly diarrhea

April 01, 2015 | Patricia Harriman

Dr. Nimisha Parekh, director of the UCI Health inflammatory bowel disease program

Poop is on the cutting-edge of research into the cure for Clostridium difficile, a diarrhea that is one of the most deadly, hard-to-eradicate and common infections.

According the latest CDC data published recently in The New England Journal of Medicine, C. diff caused 500,000 illness and 29,000 deaths in 2011, higher than any previous year.

Promising experimental treatment

Physicians with UCI Health are using a promising experimental treatment called fecal microbiota transplant, or FMT, which involves placing the stool of a healthy donor into a sick person’s intestine. Research has found that gut microbiomes are essential to digestive health, and the microbiomes in healthy donor stool may help to restore proper bacterial balance and eliminate the C. diff infection.

Dr. Nimisha Parekh, director of the UCI Health inflammatory bowel disease program, is investigating FMT’s effectiveness as an experimental treatment for treating C. diff infections that don’t respond to drugs.

Patients like 58-year-old Michael Moeller, who had been suffering from increasingly debilitating diarrhea for more almost a year, despite taking antibiotics.

“I felt physically better in just one day,” Moeller said.

Patient response is evaluated at four and eight weeks after treatment by testing stool samples for signs of the infection.

Gut bacteria — a complex world

“There are more than 1,000 species of microorganisms in the human gut, and we are only beginning to understand the complex functions that our gut bacteria perform,” Parekh said.

“The results of this study will add to our understanding of how the bacterial composition of a healthy donor’s stool helps fight the C. diff infection. Our ultimate goal is to identify and isolate the specific bacteria that will beat this bug.”

C. diff treatment challenges

C. diff releases toxins that attack the lining of the intestine, resulting in fever, cramps and severe diarrhea.

Antibiotics, which usually save lives, can actually put patients at risk by killing off the naturally occurring intestinal bacteria that normally keep C. diff in check, and are often ineffective for treatment. The chance for recurrence is 20 percent after initial treatment with standard drugs, and jumps up to 40 percent to 65 percent after the second episode.

This high failure rate has prompted the quest for more effective treatments, and stimulated a renewed interest in FMT, which has deep roots in veterinary science. Fecal enemas were first used in 1958 to treat pseudomembranous colitis, and administered in 1983 for C. diff infections.

UC Irvine has been authorized by the Food and Drug Administration to administer the FMT treatment, currently classified as an investigational drug. 

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