Faecal transplantation

faecal transplantationFaecal transplantation (transmission of foreign faeces into the patient’s intestine) was developed as a therapy against antibiotic-associated colitis (Clostridium difficile), which was previously treated mainly with the antibiotic vancomycin. The Infection with Clostridium Difficile has a wide range of symptoms that you don’t want any patient. An infection with Clostridium difficile occurs mainly in patients treated with antibiotics, which mainly fought the beneficial bacteria of intestinal flora. In medicine, faecal transplantation is also referred to as faecal therapy, faecal transplantation or faecal bacterial therapy. Today, science is investigating the connection of intestinal flora dysbiosis with all sorts of diseases such as depression, multiple sclerosis, autism, allergies and more. I therefore believe that faecal transplantation can also be an opportunity to cure or at least alleviate many diseases.

Of course, the performance is not particularly appetizing. But the whole topic intestinal flora is something unpleasant to deal with only if a chronic disease increases the stress of suffering. And it is often not primarily about diseases of the intestine. The health of the intestine is a basic requirement for the health of the entire body.

Before I would go for a faecal transplant, I would first try an Digest-remediation, i. e. Digest-cleaning with oregano oil and flea seed shells and Digestion with probiotics and prebiotics. Oregano oil has an inhibitory effect against Clostridium perfringens even at small amounts.

Friends of television and moving pictures can enjoy watching a contribution by Quarks& Co. on the topic of faecal transplantation at WDR: http://www1.wdr.de/fernsehen/wissen/quarks/sendungen/sbdarmfremdedarmfloragegenkeime102.html

Indications

Fecal transplantation could be used wherever disordered intestinal flora or dysbiosis is the cause of the disease. The following diseases could therefore be alleviated or even cured with faecal transplantation:

Adiposites

There is also a connection between body weight or calorie consumption and the intestinal flora: faecal transplantation was also tested on laboratory mice. If mice with sterile intestine were transplanted the faeces of “adipose” mice, then these also became obese. In obese mice the hormone leptin is missing. But especially the ratio of Bacteroides and Firmicutes was disturbed.  Firmicutes were outnumbered. The Bacterioides Firmicutes Ratio gives information about the tendency to overweight a person. A weight loss also leads to a shift in the relationship back to Bacteroides.

The relationship between bacteroides and firmicutes in the intestinal flora has an influence on the energy-consuming potential of the intestinal flora to metabolize fatty acids and polysaccharides from food.

So far no scientific proof of the effectiveness in humans!

Practical example

A 32-year-old American woman suffered from diarrhea, which was the result of an antibiotic. The bacteria from trunk Clostridium Difficile, which were the trigger, were fought first with Metronidazol, then with the very expensive Vancomycin. But since Clostridia are spore-forming agents, these spread again and again, because the antagonists (the “good” intestinal flora) were no longer present. A bowel transplant cured her very quickly. Her donor was her own at the time only slightly overweight daughter. Since this transplant, she’s gained weight.

The glass is half full. This means that you can also lose weight with the right intestinal flora.

And some doctors with probiotics have been working on themselves for years. It’s going into the money. Wouldn’t it be great to pug the intestinal flora of a healthy person in one fell swoop? What you need? faeces….

Multiple Sclerosis

It has been found that a (negative) changes in the intestinal flora of mice can increase the likelihood of MS-like disease called EAE (experimental autoimmune encephalitis). Just as with MS, EAE leads to demyelination and disturbed nerve conduction. As this disease is accordingly comparable to MS, it was possible to investigate MS in mice on the basis of this disease.

In the intestinal flora of MS patients, an increased number of bacteria called Methanobrevibacteriaceae was found. Butyricimonas bacteria were found more frequently in the intestinal flora of the control group. This bacterium synthesizes butyric acid, which has an immunosuppressive effect in the intestine.

Does the intestinal flora cause MS?

In any case, it can be said that the intestinal flora differs from that of other diseases such as obesity. There is definitely a correlation between intestinal flora dysbiosis and MS. So it is obvious to replace the intestinal flora with a faecal transplantation in one fell swoop.

Professor Borody from Australia reported 3 case studies from the year 2011. 3 patients were treated with stool transplants for chronic constipation. The MS symptoms also improved. Since MS shows its symptoms in spikes, it took years of waiting until it was made public. See also this book: 

MS is also a disease of civilisation related to nutrition. Nutrition directly affects the intestinal flora.

So far no scientific proof of the effectiveness in humans!

Morbus Crohn

In addition, there were no relevant studies, but case series and successful individual healing attempts, which suggest that a faecal transplantation can help with these diseases. I would certainly try that as a person affected. But there must also be a doctor who supports you.

So far no scientific proof of the effectiveness in humans!

Colitis Ulcerosa

The intestinal flora of colitis patients is disturbed. There are less bacterial species in the intestine of the colitis ulcerosa sufferers. The proportion of Firmicutes and Bacteroides is much lower than in healthy people.

Studies, in order to achieve a successful treatment with faecal transplantation, has been negative or they were not as successful as hoped, because improvements were not of duration. In some cases, however, healing of the inflammation occurred.

Personally, I do not believe that a one-time faecal transplantation will do anything because the intestine itself is easily inflamed. Any kind of bacterium, whether good or bad, is too much. Therefore I could imagine that a Colon Hydro therapy with fasting phase for the recovery of the intestine with subsequent stool transplants and probiotics administration could be effective.

But I am also convinced that pharmaceutical companies and even health insurers have no interest in financing studies on this.

If you could find a doctor to help you, it’d be worth a try. Again and again doctors say that the side effects or risks are not known and can’t be estimated (and I agree with them). But if you suffer from a chronic intestinal disease for years and conventional medicine cannot offer you much, as tablets to suppress symptoms, the willingness to take risks increases.

Obstipation

That clogging is related to a disturbed intestinal flora has been described on many websites and in many books. The intestinal flora can be restored very quickly with a faecal transplant. But: Whoever then feeds badly again afterwards and destroys his intestinal flora will probably have to live permanently with his constipation.

Irritable bowel

So far, there is only evidence that faecal transplantation can help. However, these hints are enough for me, but I do not represent the health insurance companies. :-)

2 irritable bowel patients stool of a healthy donor had been transferred. One was healed, while the other one was free of symptoms for at least a few weeks. For me, this is clearly a positive sign that faecal transplantation could be a good treatment option for every irritable bowel patient, which promises a chance of recovery. (More about Irritable bowel: Irritable bowel)

Coeliac disease

Imagine that follow in the direction of studies. Gluten sensitivity is at least more widespread than one might think. Gluten is also associated with the Leaky Gut syndrome – no wonder, because the amount of it makes the poison. Today’s wheat should contain 10x more gluten than the original wheat. In order to make the rolls more successful, a high performance wheat was bred. So if bacteria strengthen/protect the intestinal wall, this can only be beneficial. But the easiest way is to leave out the poison.; -)

Type 2 diabetes

In short: Nowadays there is always an connection to the intestinal flora. But that’s too high for me.

Alzheimer

Brainfog etc. is related to the toxins that produce pathogenic germs. If these germs are suppressed, the fog should also warp. Whether these toxins leave permanent damage is the question.

Parkinson

From case reports it is known that a faecal transplantation can help with chronic constipation. In patients with chronic constipation due to Parkinson’s disease, it has been observed that not only the stool frequency has improved after a faecal transplantation, but also the Parkinson’s symptoms have decreased. But here again a meaningful study is missing, which is certainly not paid for by BigPharma.

Autism

Autistic people have found at least one connection: autism and intestinal flora.

So a stool transplant should also be helpful here.

Depressions

In the article “Depressions Defeat – A Success Story” Vinko reports on his successful fight against his depressions, which started after a long antibiotic therapy.

His fight against depression took a positive turn when he built his Darmflora. It would be nice if orthodox medicine would also acknowledge this connection. At least this would be the start of an attempt to combat depression with colon hydrotherapy and subsequent faecal transplantation. But BigPharma also has to earn money. A tragedy, it’s about getting depressed.

The perfect faeces

”I don’t know, because I do!”

How do you get the perfect faeces? Who is really healthy these days? At some point, every person has taken medication or has an unhealthy diet. How do you get the perfect faeces? If I had the choice, I’d take the faeces of a person who does a lot of sport, eats healthy food and is as young as possible. Perhaps good faeces will become the product of the future?

What other possibilities are there? Maybe from the animals closest to us. What do monkeys actually eat? At least that’s not what food manufacturers advertise on TV, at least not for.

Only healthy and fibre-rich vegetables are brought to the table or stomach in the monkey house. Here and there an insect. There must be a healthy intestinal flora. As for other parasites etc…. If there were possibilities to limit the risk, why not? Some zoos could turn the excrement of their apes into money. There’s another way:

RePOOPulate

How fake faeces can cure diseases.

Canadian scientists around Dr. Emma Allen-Vercoe have used something like a robotic bowel to breed fake faecess. This fecal bacterial mass of 33 different types of bacteria was transplanted to 2 patients with therapy-resistant CDI with impressive success by colonoscopy. It is not the most glamorous invention, but it works, because after 3 days the patients were cured.

No clostridia were found after a 3 month follow-up checkup. And unlike probiotics, these bacteria were able to colonize the intestine permanently.

The bacteria came from the stool of a 40-year-old woman who had not taken antibiotics in a decade. Researchers cultivated bacteria from the faeces and the healthiest types form rePOOPulate – an alternative to the donor faeces in faecal transplantation.

RePOOPulate is still in the prototype phase and as such has not yet been approved for treatment by the Canadian health authorities. The future goal is to develop a product that will be administered in tablet or capsule form similar to today’s probiotics.

Apart from that, I have listed a lot of probiotic preparations in one of my articles to find out which probiotics should be taken in order to reintroduce as many different good intestinal bacteria as possible: Probiotics comparison or Probiotics.

PharmaBiomes vision of the future

PharmaBiome is a Swiss startup that is working on a method of breeding all useful intestinal bacteria to provide an alternative to faecal transplantation. I am curious to see what happens and will continue to observe the startup.

Faeces compatibility

Research (Peer Bork from the European Molecular Biology Laboratory (EMBL) in Heidelberg in the journal “Science”) has shown that a certain amount of bacteria can penetrate the stool after a certain period of time after faecal transplantation. The compatibility between donor and recipient is therefore also very important. In my opinion, however, this is also quite logical: the recipient has a different digestion and different dietary preferences, etc.. Depending on the food for the bacteria, some will survive and others will literally starve to death.

Fecal transplantation costs

The costs for treatment of the faeces, the previous screening and the faecal transplantation himself must of course be covered by the patient. faeces / intestinal bacteria simply cannot be patented. They are not covered by the health insurance funds. However, EU health insurance funds spend three billion euros every year to treat patients with Clostridium Difficile infection. Of course with patented medications. So much for the sermon. Welcome to absurdistan.

News on costs: In Cologne, stool transplants are only performed in cases of severe clostridia infestation. In this case, all costs will be borne by the Fund.

According to Dr. Siegel (Chief Physician Internal Medicine, Department of Gastroenterology, Diabetology/Endocrinology and Nutritional Medicine at the St. Josef’s Hospital in Heidelberg, Germany), the material costs are approximately 180 euros for faeces refurbishment. In addition there are approx. 650. – Euro for the screening of the donor’s faeces.

I got off cheaply with my intestinal remediation. The most important thing is of course the intestinal cleansing (see article): Intestinal Cleansing Instructions)

Procedure

Conditions

  • A suitable donor must be found
  • The patient should have at least 3 bowel movements per day
  • Discontinuation of antibiotic administration, if possible, 2 days before the faecal transplantation.
  • Written consent

Tests of the donor

  • The donor is first and foremost tested for all possible infectious diseases. This is particularly time-consuming because there is a broad spectrum of infections that could be transmitted by means of faecal transplantation.
  • Especially gastrointestinal diseases (chronic inflammatory intestinal diseases or “irritable bowel”) should be excluded.
  • The donor must not have taken anibiotics within the last 3 months.

Preparation of the faeces suspension

  • The stool transplant is obtained from about 30-50g (by nasal probe) or the entire portion but at least 170g (by colonoscopy) of fresh stool. Fresh means: Less than 6 hours old.
  • This stool portion is diluted with a sterile saline solution and homogenized by shaking and/or stirring.
  • To remove solid matter, the stool graft is cleaned by multiple gauze filters.
  • The faecal graft is now introduced into the colon either through a nasal probe or through the colon’s working channel.
  • The stool suspension is distributed over the entire intestinal mucosa

Preparation of the patient

    • antibiotic therapy of clostridium difficile infection andPerenterol
      gabe
    • When applied by nasal probe: administration of a proton pump inhibitor

.

  • in the evening and morning before the stool transplant
  • When applied by colonoscopy: Colon cleansing with polyethylene glycol Elyte (PEG)

Application via nasal probe

    • Inserting of the nasal probe followed by checking the position

.

  • application of the stool suspension via nasal probe
  • Rinsing with 25ml physiological saline solution
  • Removal of nasal probe
  • Food intake is then possible.

Application via colonoscopy

    • colonoscopy up to the terminal ileum
    • The faeces suspension is applied to the intestinal mucosa. At best the largest part in the terminal ileum and in the colon ascendens

.

Aftercare

Regular checks on CD toxins.

Acid-resistant capsules

In the Cologne University Hospital, patients with a Clostridium-difficile infection (CDI) with encapsulated stool of a donor with a healthy intestinal flora were treated. The two patients are free of symptoms. The disturbed intestinal flora was successfully regenerated. The placement of the probe is associated with a certain risk for some patients, and because colonoscopy is perceived by patients as something unpleasant, faecal transplantation with frozen stool packed in capsules could be a good alternative. The researchers are planning studies to find other applications. Infectiologist Dr. Maria Vehreschild runs the program in Cologne.

In addition, faecal transplantation in capsule form is also preferable for another reason: The delivery of the faeces by the donor is time-bound to the actual colonoscopy during normal faecal transplantation. The faeces must be prepared promptly and then administered immediately. This temporal coupling is missing when taking stool capsules. The capsules can be taken independently of the time of donation. An industrial production of intestinal flora capsules would be a conclusion. Repoopulates in the form of capsules would probably be optimal.

It is very likely that a standardized stool capsule will be launched on the market within the next 3-5 years, which will replace classical faecal transplantation. A prior bowel cleansing would probably still be advantageous. Here you can find an article on the topic:”Intestinal cleaning at home (instructions)“.

Capsule production

The stool is diluted with saline solution and the bacteria are separated from the stool using centrifuges and a filter system. Now you can freeze them with the help of glycerine and fill them into the capsules.

American researchers led by Dr. Ilan Youngster from the Massachusetts General Hospital (Boston) have carried out the transfer of the intestinal flora per capsule as early as 2014. In a pilot study, 90 percent of patients with chronic CDI were cured.

Guidance and study for self-administration per enema

For DIY fans (Do it yourself), the Canadian gastroenterologist Michael Silverman has conducted a small study to test the efficacy of faecal transplantation in self-administration. This is published in the magazine “Clinical Gastroenterology and Hepatology“. And anyone who has ever made an enema himself will have no problem with the procedure. I have not tried it and would rather leave it to the experts (in white).
What you need?

  • Faeces donation
  • salt solution
  • Hand mixer
  • Enema bag

One could thus recolonize one’s own intestine by transferring the stool by one’s own hand. But all the precautions (especially tests) should keep everyone from doing this themselves. Above all, how do you know if the dispenser faeces is OK? You don’t just get good stuff in the back door.

Background and objectives of the study

Forum at this study went
Clostridium difficile infections were investigated to see whether low-volume self-assisted stool transplants or those administered by family members could cure Clostridium difficile infections definitively.

A subgroup of these patients experienced only temporary clinical improvement, depending on long-term oral vancomycin therapy. These patients suffer significantly from recurrent diarrhoea and financial costs due to permanent antibiotic therapy.

Findings

In a case series of seven patients (n = 7) this treatment was 100% successful with 14 months of follow-up.

Conclusions

Low volume self-administration fecal transplantation per enema is an effective and safe treatment option for patients with chronic recurrent Clostridium difficile infection who did not respond to other therapies. If this approach is made accessible in the health care system, it has so much potential that the number of patients who are likely to benefit from this therapy is increasing dramatically.

Clostridium difficile infection (CDI) is a common cause of normal and hospital-acquired diarrhoea, which usually occurs after taking antibiotics. A common problem with CDI is the high relapse rate in up to 40% of patients with at least one relapse. At some point, these patients can only be helped with the very expensive vancomycin.

In 1958 Eiseman was the first to administer or transplant human faeces in patients for whom no other treatment has led to long-term success. This was done by nasal probes, or by inlets with correspondingly high volumes through colonoscopy.  faecal transplantation has many advantages including low cost, lack of side effects, no resistance problems and a very high success rate.

In order to enable fecal transplantation at home, Silverman et al. have accompanied patients and their families through the process and, if necessary, supported them by providing laboratory tests.

Methods

Patient and donor selection

All patients (receiver of the faecal transplantation) received a complete medical history and physical examination.

Potential family members were selected by the patients as fecal donors and eventually, unless one of the following contraindications showed up:

    1. any gastrointestinal disease, including stomach ulcers, gastroesophageal reflux, irritable bowel syndrome, inflammatory intestinal diseases, or polyps

>.

  1. any malignancy
  2. the use of antibiotics or hospitalization within the last 3 months. (In my experience, three months are not enough here, especially if the antibiotics were administered over a longer period of time, as the intestinal flora is usually permanently damaged.)

Previous tests

All donors were tested for HIV, syphilis, hepatitis A/B/C Helicobacter pylori and human T-lymphotrope virus 1/2.

The blood of the recipient was tested for: complete blood count, sequential multichannel analysis with computer-20 (Chem-20), serum protein electrophoresis, serum immunoglobulins, HIV and antigliadin antibodies.

The faeces of donors and recipients has been studied for:

In addition, the faeces samples of the recipients were sent to a reference laboratory before the faeces transplantation in order to more precisely define the Clostridium difficile.

Instructions (equipment and steps)

The recipients were on maintenance therapy with oral Saccharomyces boulardii (Perenterol) 500 mg twice daily plus 500 mg metronidazole 3 times a day or 125 mg vancomycin 4 times a day to make sure they were asymptomatic 24-48 hours before treatment. All patients were asked to return to the clinic 2 weeks after treatment.

Required equipment:

    1. bottle of normal saline (200 ml);

.

    1. An irritator like theinlet cup from P. Jentschura, 1 litre

.

  1. Standard kitchen mixer (1 litre capacity) with markings for volumes on the side. (There are alsocheap blenders for experimenting.)

Footsteps

The following instructions have been given to recipients and donors:

    • Stop taking vancomycin / metronidazole 24-48 hours before the procedure. (You don’t want to kill the intestinal flora of the transplanted stool.)

.

  • Continue taking the S boulardii (Perenterol) during transplantation and 60 days after.
  • 50 ml of stool (volume of solid stool) from the donor immediately before administration (less than 30 minutes) with 200 ml of physiological saline solution into the mixer.
  • Mix until the mixture is liquefied,”milkshake” consistency.
  • Pour the mixture (about 250 ml) into the enema bag.
  • The patient’s enema should be carried out as described in the instructions of the enema bag or enema cup set. The patient should hold the infusion solution as long as possible and resist the stool pressure. So lie on the left side as long as possible, so that the stomach urge is prevented.
  • This procedure is best carried out after the first bowel movement of the day (usually in the morning).
  • If the diarrhea returns within 1 hour, the procedure can be repeated immediately.

What else is important:
Detailed information on the potential risks and benefits of the procedure, including its experimental character, has been made available to patients and donors. 

Findings

All patients developed CDI in the hospital and then several patients developed relapses at home. All patients were home at the time of transplantation and had recurrent CDI confirmed by faecal toxin. Six of the 7 (patients 1 to 5 and 7) had relapses after treatment with at least 2 passages of oral metronidazole 500 mg PO 3 times a day for 14 days. One patient (patient no. 6) developed peripheral neuropathy during treatment with metronidazole and the drug was not discontinued.

All patients were symptom-free in multiple rounds of oral vancomycin. But they relapsed when vancomycin was discontinued. No wonder the spores haven’t been killed. All patients were previously treated with vancomycin 125 mg PO 4 times per day for 14 days, then 500 mg PO were administered 4 times per day for 14 days, then the vancomycin was sneaked out while S boulardii (Perenterol) was used. And yet there was a relapse after the treatment.

Seven patients participated in the mini study (Table 1). All procedures were carried out at home and by yourself or administered by a family member. No patient had recurrent CDI after treatment. No side effects were found. One patient developed a post-infectious irritable bowel symptom after transplantation, alternately constipation and diarrhoea, but consistently negative toxin tests, and no recurrence of chronic diarrhoea. Repeated colonoscopies showed no signs of colitis. Two patients were treated with antibiotics for urinary tract infections after the transplantation. One patient received intravenous cefazolin for perioperative prophylaxis of a hip surgery after transplantation. But despite antibiotic therapy, none of these 3 patients had a relapse to CDI.

Discourse

In this case series of highly motivated patients, faecal transplantation was both well tolerated and effective. No patient needs further treatment and there was no therapy failure, although 3 patients took antibiotics in the post-transplant phase.

That wasn’t a controlled trial.

A enema with faecal transplant with low quantity is an effective and safe option for patients with chronic recurrent Clostridium difficile infection who do not respond to other therapies. The therapy has a lot of potential. Further, especially larger studies are definitely justified.

Patients
patientAgesexBasic disease in the hospitalDuration of symptoms before STTreatmentshandlertracking according to STrelationship with donor
162MSubarachnoid hemorrhage18 months1son6 monthsFather
238WB-cell lymphoma12 months1self12 monthsSister
376Wheart failure, Parkinson’s disease8 months1daughter14 monthsMother
430Mliver transplant19 months1wife7 monthsHusband
572Wpneumonia8 months1self10 monthsGrandfather
687Mpneumonia23 months1self7 monthsFather
788Mpneumonia, multiple myeloma6 months1son4 monthsFather

Video

http://www.3sat.de/mediathek/?mode=play&obj=57931

Where?

Fecal transplantation in Germany

  • Berlin
  • Braunschweig
  • Dresden
    • Universitätsklinikum Carl Gustav Carus Dresden
  • Erlangen
  • Starnberg
  • Frankfurt
    • Frankfurter Universitätsklinikum
  • Freiburg
  • Heidelberg
    • Josefskrankenhaus
  • Hannover
    • Medizinischen Hochschule Hannover
  • Jena
    • Universitätsklinikum Jena (Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie)
  • Köln
    • Uniklinik Köln (Kapseln)
  • Leipzig
  • München
    • Klinikums der Ludwig-Maximilians-Universität (LMU) München (Reizdarmsyndrom)
  • Nürnberg
  • NRW
  • Regensburg
  • Saalfeld
    • Thüringer Kliniken
  • Starnberg
    • Zentrum für Endoskopie, Oßwaldstraße 1, (PoliCenter), 82319 Starnberg
  • Tübingen
    • Uniklinikum Tübingen
  • Trier
    • Abteilung für Innere Medizin I im Brüderkrankenhaus Trier
  • Ulm
    • Zentrum für Innere Medizin, Klinik für Innere Medizin III, Sektion Infektiologie und Klinische Immunologie, Universitätsklinikum Ulm, Albert Einstein Allee 23, 89081 Ulm, Deutschland

Fecal transplantation in Austria

  • Graz
    • Uniklinik für Innere Medizin in Graz
  • Wien
  • Innsbruck
    • Innsbrucker Uni-Klinik für Innere Medizin I

Fecal transplantation in Switzerland

  • Zürich
    • Universitätsspital Zürich (USZ)

Fecal transplantation in the Netherlands / Holland

  • Amsterdam
    • Academic Medical Center der Universität Amsterdam

Further Links

Still coming.

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