"I thought I was going to die": why are patients no longer stuck with stool? Australia news

BOnnie Wortmeyer has been in poor health in recent years. Among the main problems she has faced, there is a double lung transplant and what she calls her "poop transplant", which, she says, has changed her life.

As she was recovering from her double lung transplant, Wortmeyer was exposed to many antibiotic treatments, which made her susceptible to contracting the Clostridium difficile bacterium. C diff, as we know, is a nasty bacterium, putting life in danger, making life almost unbearable for its victims.

For Wortmeyer, in her late fifties, when she was attacked at C Diff, it meant constant diarrhea and debilitating stomach cramps.

"I do not exaggerate, I thought I was going to die," she says. "I could not eat anything without it happening directly through me. I could not hold anything back and it was almost like leaving the table that I had diarrhea. "

A few years later, Wortmeyer broke his leg and found himself again in the hospital, with high doses of antibiotics administered. This visit to the hospital brought her into the path of Dr. Sam Costello, gastroenterologist, founder in 2013 of Australia's first public stool bank, BiomeBank in Adelaide, which he now heads with Dr. Rob Bryant .

Costello prescribed a stool graft to Wortmeyer, who felt the effects of the treatment within hours.

"I think it was instantaneous," she says. "I had to wait an hour after the procedure to use my intestines and, from that moment, I was absolutely frozen.

"Dr. Costello said that if I had not had the poo graft, it would have had to take a large part of my intestines and I would have a colostomy bag."

Wortmeyer is one of the thousands of patients in the world who have been released from crippling C diff symptoms by fecal microbiota transplantation, a medical term used to refer to a "poop transplant". Studies show that fecal transplants have an 80% success rate in Diff C treatment and that many patients feel better within hours, like Wortmeyer.

The intestinal microbiome includes bacteria, fungi, viruses and other organisms that line the intestines. This ecosystem does a lot – including acting as a protective barrier for the immune system, producing vitamins, breaking down food and even encouraging healthy brain development.

Antibiotics go through this system and not only erase the disease or germ they are there to kill, but also many other healthy bacteria that the body needs to function. This is where stool transplants can help, by repopulating the microbiome with the bacteria of a healthy person.

The FMT is a relatively simple procedure. When performed in a reputable medical facility, it consists of diluting the given feces in saline solution and inserting them in the patient by an enema, a colonoscopy, a naso-enteric tube or pills.

Due to inconsistencies between states in the collection of records, the actual extent of C diff infection in Australia is not known. However, a 2018 report on the burden of C diff in Australia published by the Australian Commission on Safety and Quality of Health Care estimates there were 113 cases of serious illness nationwide and that 45 people died of serious infections by C diff in 2015.

There is not yet a national register of the exact number of Australians who undergo fecal transplants, but in South Australia about 30 per year.

What was scammed about the medical industry 10 years ago is now a field of medicine that is rigorously tested as a solution to all kinds of diseases, from inflammatory bowel disease to depression and obesity. While many clinical trials are underway in Australia and around the world, fecal transplantation is approved in Australia only for the treatment of C. diff infection. There is evidence that fecal transplantation could lead to remission of ulcerative colitis, but this treatment is being reviewed by the Therapeutic Goods Administration, with the help of health professionals working to develop guidelines on how to treat ulcerative colitis. regulate it.

"Clostridium difficile is an organism that can grow in the gut after the removal of a person's native gut flora, often because of antibiotics," says Bryant. "The fecal transplant contains a large number of beneficial microorganisms, which rival C diff in the intestinal ecosystem and prevent it from multiplying in the intestine."

One of the main challenges of the faecal graft industry is the availability of drugs. That is, the availability of the amount of poo needed to generalize the procedure.

Costello and Bryant approach Guardian Australia through the rigorous donor process, where less than 10% of potential donors get this discount.

"We have a standard selection process in which people first go through a medical interview, define questions to which they respond in terms of their medical problems or the risk factors for medical problems," says Costello. "It would be similar to the questions you would ask a blood donor.

"There are some additional questions because we think that the potential risk of disease transmission through stool transplants may be different from the risk of transmission of a disease during a blood donation. If donors were successful, they would then undergo a limited physical examination, a blood test to detect primarily infectious risks, but also some metabolic risks, as well as an badysis of infections in the stool. If they succeed all these steps, they could then become stool donors. We would do tests both before and after the collection period to avoid any new infections during the donation period. "

Fecal grafts present a potential risk of transmission of the disease, which explains the important screening of donors. But other risk factors also exist.

"Animal studies have shown that fecal transplantation can lead to obesity," says Bryant. "Although these studies have only been conducted on mice, this has not been well demonstrated in humans, but we believe that there may be a risk of problem transfer." metabolic such as obesity with the FMT. "

The average treatment of FMT requires 50 g of feces and the average donation of feces is about 100 g. The clinic encourages donors to bring their donation as fresh as possible – on the way to work, for example.

"Also," says Bryant, "we have beautiful clean squeaky toilets here at the stool bank and we are always looking for more high-end saddles."

After the rigorous selection process, donors receive $ 25 for each dropped poop they deposit for further examination before being used as drugs.

Dr. Craig Haifer, a Sydney-based gastroenterologist, is studying for his doctorate whether the FMT in pill form will be an effective treatment for patients with inflammatory bowel disease. Unlike C diff, inflammatory bowel disease is chronic and mainly affects people aged 20 to 30, preparing them for future health problems.

He is conducting one of the thousands of studies done worldwide on FMT and also hopes to establish a list of guidelines for the use of fecal grafts in Australia, as the service grows. .

"Australia is a bit of a world leader in FMT," Haifer said. "The ground is moving so fast. We will use it more or less well than we do now, so this is a pretty exciting field. "

The need for the FMT to treat diff C alone is increasing rapidly with our aging population and the use of antibiotics by the medical world.

It is not surprising then that Wortmeyer was left with a new bacterial outbreak 12 months after her first "poo graft".

"I did well for 12 months, then I had to go back to the hospital because of an infection in my chest," says Wortmeyer.

Several cycles of antibiotics have seen the C diff come back to him and the intestinal problems have come back.

"I had another shit transplant," she says. "The second time, it took about a week before everything was restored."

She hopes that a new series of antibiotics will not report it, but can not believe how unknown the procedure is, especially since it has been so instantly effective.

"When I had my first poo transplant, not so long ago, it was amazing how many doctors did not even know it," she says.