Desperate Times Call for Desperate Measures

And what could be more desperate than willingly submitting to having someone else's feces inserted into your colon?  Yes, fecal transplants are an actual treatment for serious cases of C. difficile.  A 2013 study published in the New England Journal of Medicine found that fecal transplants were "significantly more effective for the treatment of recurrent C. difficile infection than the use of vancomycin."  

Some had no symptoms at all after the first day. So, what exactly did the fecal transplant entail?

Duodenal Infusion

The first question that sprang to mind for many of these patients was probably, "how are you going to get the feces where it needs to be?" The answer, while slightly reassuring, is still not pleasant to ponder.

For each patient, a nasoduodenal tube was placed.  This means a small-diameter flexible tube was inserted into the nose and pushed down the esophagus, into the stomach, through the pyloric sphincter which separates the stomach from the intestines, and into the duodenum.  The duodenum is the first portion of the small intestine.

Many people gag during the procedure when something as innocuous as a nutritional supplement is to be ingested through the tube. Imagine, therefore, the difficulty of having a bag of prepared donor feces attached to one end. In fact, some of the patients in the trial at first rejected the treatment because they were so disgusted by the idea. Researchers knew they would need a more aesthetically pleasing medication route if they were to convince chronic sufferers to basically ingest another person's feces.

Other methods were attempted, including jejunal catheters and fecal enemas, but they were either not well-tolerated or didn't work as well as the nasoduodenal tube. Finally, after years of trials, researchers were able to create a gel capsule form for fecal transplant that effectively eliminated C. difficile in trial participants.

Encapsulating Feces

It's not as simple as sealing up some feces in a capsule, as one might imagine. "Freshly passed" donor feces was placed into a special solution than run in a centrifuge for a few hours, resulting in tiny pellets of fecal microbes.  These microbes were then suspended in another solution and the resulting mixture was carefully placed into gelatin capsules, about half a milliliter in each one.  That capsule was placed inside another capsule, then placed inside another capsule, resulting in a clean pill that would be easy to swallow, both physically and mentally.

The patients underwent a colonic irrigation prior to ingesting anywhere from 24 to 34 of the capsules over a time period of five to 15 minutes on an empty stomach. The multiple gelatin casings kept the fecal sediment intact until the capsules had reached the small intestine, resulting in optimal placement for transplant.

Every person in the trial was cured of their chronic C. difficile infection after just one round of oral treatment. 

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Followup testing also showed significantly increased populations of healthy gut flora and significantly decreased populations of aggressive bacteria.

Oral fecal transplant pills are an exciting step forward in the treatment of chronic intestinal infections.  Researchers are looking at ways to streamline the encapsulation process in order to produce treatment on a wide scale, including freeze-drying donor stool. The next mental block to hurdle: increasing the number of people who are willing to donate.