Healed bowel thanks to stool donation
Luise Heine has been an editor at since 2012. The qualified biologist studied in Regensburg and Brisbane (Australia) and gained experience as a journalist in television, in the Ratgeber-Verlag and in a print magazine.In addition to her work at , she also writes for children, for example for the Stuttgarter Kinderzeitung, and has her own breakfast blog, “Kuchen zum Frühstück”.
More posts by Luise Heine All content is checked by medical journalists.Healthy or sick? This is also decided by the intestinal bacteria. A new form of treatment gives hope for some diseases: faecal transplantation. A sick person is given the stool of a healthy person. The results are astonishing.
Around 400 square meters - that's the surface of the human intestinal mucosa. This corresponds to the living space of a medium-sized villa. So it's no wonder that the intestine not only digests and transfers nutrients into the blood, but also plays a major role in defending against pathogens and toxins.
In the large intestine, he is supported by an army of microorganisms. There are, however, great individual differences: each person harbors his or her very own multicultural bacterial society. Science is only just beginning to fathom what influence this so-called microbiome has on the health of its host.
For example, several studies have shown that sick people have a different intestinal flora than healthy people. So what could be more natural than to try to swap the bacterial spectrum of a sick person for the intestinal flora of a healthy person?
Stubborn intestinal germ
This is exactly what the gastrointestinal specialist Prof. Max Reinshagen at the Braunschweig Clinic has already done several times. And that with a very special clinical picture: the chronically recurring clostridial colon inflammation (clostridial colitis). “It works extremely well with these patients,” reports Reinshagen.
At the beginning there is the search for a suitable donor. "Usually you choose young, healthy people for whom the intestines do not cause problems," explains Reinshagen. These are first checked for diseases such as HIV or hepatitis. If the donor is completely healthy, he gives a sample of his stool. This is dissolved in a saline solution and then filtered through a gauze. Diluted and purified in this way, the stool sample is ready to be "transplanted" into the recipient's intestine.
The bowel is cleaned beforehand, because the donor stool is transferred via a colonoscopy. In addition to the camera, the endoscope has a so-called flushing channel through which the stool fluid can be injected as soon as the doctor has reached the diseased intestinal area.
The result of the unusual treatment: the patient's symptoms subside within a few days. “It is assumed that the donor's bacteria are pushing back the clostridia,” Reinshagen explains the principle. This gives your own intestinal flora the little breather it needs to stabilize. Because after a few days to weeks, the donor flora disappears again and is replaced by the patient's own.
Episodes of diarrhea and colic
But why does the transplant work so well for Clostrid patients? About one in twenty people carries the intestinal germ Clostridium difficile. Mostly he leads a shadowy existence. It does not cause symptoms, nor does it spread any further. The other bacteria in the gut keep it in check. However, if the natural intestinal flora is unbalanced - for example by antibiotic therapy - the germ likes to take advantage of the chance and spread. Typical complaints: diarrhea, sometimes bloody, and severe, cramp-like pain.
The clostridia can be very stubborn: In around every tenth person affected, the intestinal flora no longer prevails, and almost all common antibiotics are ineffective against the germ. Worse still, with each relapse, the arsenal of effective antidotes shrinks. At the same time, the risk of new attacks increases. Doctors then speak of recurring (recurrent) clostridial colitis.
"Clostridia also produce a poison, the patients feel quite sick," says Reinshagen. Accordingly, the suffering of those affected is. It is so big that those affected are ready to endure the unusual and, at first glance, somewhat daunting “fecal transplantation”.
Several studies have shown the success of the fecal transplant. In a pilot study from Boston, for example, in 18 of 20 colitis patients, the bacterial transfer brought calmness back into the intestines. Numbers that match the experience of Reinshagen, who was the first to use the method in Germany.
Legal catch
However, there is a catch: Fecal transplantation is not approved as a therapy in Germany. "The treatment can only take place as part of an individual healing attempt," explains Reinshagen, which means something like: The patient must have tried all common and approved methods without success. An ethics committee decides in each individual case whether the option of a stool transplant may be used as the last treatment option. The complex procedure is certainly one of the reasons why the Braunschweig gastroenterologist has only treated a handful of patients with fecal transplants in recent years.
Chance for Inflammatory Bowel Disease?
Nevertheless, the successful treatment of clostridial colitis also gives people with other chronic intestinal diseases hope. In many places, research is already underway to determine whether, for example, people with Crohn's disease or ulcerative colitis could also benefit from a stool transplant. With them, too, we now know that the intestinal flora plays an important role.
"So far, no study has been able to report success in Crohn's disease," says Reinshagen. “On the other hand, colleagues in Canada caused a stir when it came to ulcerative colitis.” They would have given 75 adults who were just going through a flare-up of inflammatory bowel disease enema with a faecal solution. It came from six different donors. At first it seemed as if the treatment would not help. “But then Paul Moayyedi and his colleagues realized that there was a subgroup among the sick that benefited most. And they all had a transplant from the same donor, ”says Reinshagen, explaining the result.
Now the researchers and the patients are looking forward to the detailed analysis of the bacterial flora of the so-called super donor. “But”, Reinshagen dampens premature hopes, “as long as one no longer knows about the mechanisms of how fecal transplantation works, a stool transplant is no therapy option for ulcerative colitis patients.” Even if it may have potential.
Disgust therapy in neutral packaging
Of course, the idea of being given someone else's stool - whether as an enema or via a small intestine tube through the nose - is not exactly appetizing. The disgust factor is significantly smaller in the context of a colonoscopy, but the procedure itself is complex. Perhaps another reason why the method, although known since 1958, has so far barely had a career.
One is therefore looking for other ways: One idea is to smuggle the purified donor bacteria into the small intestine in the form of capsules - in any case easier to use as long-term therapy. But are “fecal capsules” just as effective? At least with Clostridium difficile, this seems to be the case according to initial studies. In a study by Boston specialist Dr. Ilan Youngster recovered around 90 percent of the patients who swallowed capsules with frozen donor feces. "If that works and it is certain that there will be no side effects, the method could also be approved for us," hopes Reinshagen. “Exciting prospects,” says the researcher.
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