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Digestive-Health

26 January 2019

'Poop transplants' may help ease painful colitis

Faecal transplants – delivering a healthy person's stool into a patient's digestive tract – may be an effective treatment for ulcerative colitis.

Ulcerative colitis is a chronic inflammatory bowel disease triggering pain and bloody stools, and it can raise the odds for colon cancer.

But now, research suggests that faecal transplants – basically, delivering a healthy person's stool into the colitis patient's digestive tract – may be an effective treatment.

Restoring digestive tract

The Australian team behind the small study said the strategy may work by introducing millions of healthy bacteria into the dysfunctional tract.

"Bacteria comprise more than half of the faecal mass, [but] not all poop is created alike," explained Dr Arun Swaminath, a US gastroenterologist unconnected to the new research.

In faecal transplant, patients receive stool laden with bacteria from a healthy donor's microbiome – those internal communities of "good" bacteria, Swaminath said. And that might help restore balance to the digestive tract of people with colitis.

In recent years, "new technology has now allowed us to get a deeper understanding of the microbiome," Swaminath said. That's led to whole replacement of the colonic microbiome with donor faecal transplant.

The new Australian research involved 73 adults with mild to moderate active ulcerative colitis. The patients received a few treatments of low intensity faecal microbiota transplantation delivered via colonoscopy.

Suppressed immune system

Patients were divided into two groups: Some received pooled donor faecal matter processed anaerobically (in an oxygen-free environment), while others received their own faecal matter (essentially, a placebo, used for comparison purposes).

The result: The rate of ulcerative colitis remission was 32% for the patients who received the pooled donor stool, compared with just 9% in the placebo group.

The rate of remission in the patients who received the donor faecal matter was similar to that achieved with the best current treatments, noted a team led by Dr Sam Costello, a gastroenterologist at The Queen Elizabeth Hospital, in Adelaide.

Costello noted that many current colitis treatments suppress the immune system, and that can lead to potential side effects, such infection or even cancer.

"The most important difference in this trial compared to previous studies is the use of anaerobic (oxygen-free) stool processing," said Costello, who is also a lecturer at the University of Adelaide's Medical School.

"Many gut bacteria die with exposure to oxygen and we know that with anaerobic stool processing a large number of donor bacteria survive so that they can be administered to the patient," Costello explained in a university news release. "We believe that this may be the reason that we had a good therapeutic effect with only a small number of treatments."

Further studies

Dr David Bernstein is a gastroenterologist and director of the department of hepatology at Northwell Health in Manhasset, New York. He said the new study is "promising and the results are impressive". But he stressed that larger studies are needed "to validate these findings".

In the meantime, Costello's team has reached an agreement with a company to develop the method used in the study and conduct further studies.

"Our long-term aim is to develop rationally designed microbial therapies that can replace faecal microbiota transplantation," Costello said. "These will have bacteria in a pill that can carry out the therapeutic effect without the need to take whole faeces," he explained.

"This is obviously a better and less smelly option," Costello said.

The findings were published in the Journal of the American Medical Association.

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