Many patients have wondered whether it might be possible to improve IBD by implanting new bacteria in their bowels by means of enemas of faeces from healthy individuals. Vets have been employing similar techniques in horses for many years with apparent success. Occasional reports have appeared in scientific journals of patients whose colitis has been helped this way, but there has been a general reluctance to try this form of treatment.
It is now over 20years since I first suggested the importance of the bacteria living in the bowel in causing diseases such as Crohn’s and Ulcerative Colitis (Lancet 1991 ii 495-6). Apart from the use of probiotics – non-dangerous bacteria which have been claimed to produce a range of health benefits and which overall have not been dramatically exciting - there has been little further development of the idea.
This is not only because of the unpleasantness of handling human faeces. There has been great concern that the bowel bacteria are so numerous and difficult to identify accurately that faecal ‘transplants’ might be dangerous, allowing transmission of dangerous microbes from one person to another. Furthermore the idea that one person’s set of bacteria would be able to live in the guts of another is overly optimistic – when healthy probiotic bacteria are fed to patients, they disappear rapidly from the gut after the bacterial administration is stopped. Our defences against infection prevent ‘good’ bacteria as well as pathogens from taking permanent residence in the bowel.
However Professor Borody in Australia has claimed success with faecal transplants and now there has been a lecture by an American physician, Dr Lawrence J Brandt, published in the American Journal of Gastroenterology in February 2013. (Am J Gastro 2013, 108, 177-185) on the benefits of faecal transplants in a gut infection, pseudo-membranous colitis, caused by a bug called Clostridium difficile, which may occur after a course of antibiotic treatment. This condition is usually treated by other antibiotics, vancomycin or metronidazole, but it frequently relapses, and can present a really annoying therapeutic problem. Perhaps the best way of dealing with C diff. is to prevent it becoming established by giving healthy probiotic bacteria at the same time as the original antibiotics which cause it. However, Dr Brandt reports that a faecal ‘transplant’ can ‘effect a seemingly safe, relatively inexpensive and rapidly effective cure in the vast majority of patients’. He also claims that he has obtained remarkable symptomatic improvement in some patients with IBD treated this way – 20 with UC and 4 with Crohn’s disease.
This is of course, very new and I am not for an instant suggesting that patients should go round to their doctors demanding that they are given an enema of someone else’s faeces! The real excitement of this report is that the Americans are catching up, and becoming interested in the importance of the gut bacteria in causing IBD. This is surely the right way forward, and if some of the vast research funds available in the USA are put behind studies of the role of bacteria in IBD, and how best to manipulate the microbes, then there is every chance that we shall at long last start to make real progress in getting rid of these horrible diseases.
This article was first published on the original crohns.org.uk blog. Research has moved on since, so please check current advice with your IBD team.