Last week, Dr. Matt Clark’s column acknowledged the immense numbers of gut bacteria, characterized in new terminology as the “microbiome.”
The microbiome – the trillions of microorganisms, bacteria and other bugs in the gut – is being recognized as a body organ, almost like a kidney, a spleen or liver. Disturbances in the flora of the gut/colon now appear to be both cause and cure for some systemic diseases. Long dismissed as stool, excrement or fecal waste, “poop” pills are now treatment for recurrent Clostridium difficile infections.
Clostridium is a genus of bacteria and C. difficile is one of nearly 100 species. The name derives from the Greek “kloster,” meaning spindle, the shape of most Clostridia. Perhaps the most familiar species is C. tetani, the bug-causing tetanus, the spores of which are almost universal in soils, not rusty nails. Two others are C. botulinum, a cause of food poisoning (botulism), and C. perfringens, which develops in deep wounds as gas gangrene. Not all Clostridia are bad guys; some species hang out in the gut as commensals – not harmful to each other or their human hosts. C. difficile, or C. diff, usually makes up a few percent of bacteria in normal humans. Illness is another story.
C. diff infection can occur in hospitalized and long-term care patients, the elderly, the immune compromised and especially anyone taking or receiving antibiotics during the previous several months. Part of the problem is that Clostridia form spores, which are bacteria in dormant, resting states, awaiting a host, like C. tetani in the soil. They are difficult to remove from institutions.
Symptoms are watery diarrhea, three or more times daily, nausea and abdominal pain. C. diff toxins may be found in the stool, and other, more sophisticated tests may confirm the diagnosis. The course may worsen to pseudomembranous colitis and death, currently about 14,000 annually in the U.S. Symptoms may resolve, sometimes immediately, when antibiotics are stopped, but also can persist for weeks or months. Correction of dehydration and electrolyte imbalance plus treatment with the antibiotics Flagyl and/or Vancomycin have been standard treatments. But imagine symptoms for weeks, months or longer? What or where is the magic bullet?
Because the increasingly more powerful, broad-spectrum antibiotics kill off the good bugs, reducing the mix of commensals, other bugs such as C. diff take over, despite repeated treatment. Enter FMT, fecal microbiota transplantation. According to a January 13, 2013, New England Journal of Medicine editorial, physicians in Denver, in 1958, “administered feces by enema” to those with life-threatening PMC. The therapeutic goal was to “re-establish the balance of nature” and “correct the disruption caused by antibiotic treatment.” A Dutch study, directly comparing treatments, published in the same journal, seems to confirm earlier work.
Thankfully, donors were very carefully screened for disease, and excrements were freshly transported, within six hours, to the “study center.” Now available in marble-size and spherically-shaped “capsules,” 20 or so, they optimally dissolve downstream from the stomach. We are only as healthy as our microbiota. Yes, unappealing, but more poop pills are coming.
www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.