The phrase ‘poo transplant’ might sound more like the punchline of a 10-year-old’s joke than a genuine medical procedure.
Faecal microbiota transplants, (FMTs) to give them their technical name, though, are a legitimate treatment – and one that has now been given the greenlight by The National Institute for Health and Care Excellence (NICE) to be offered to help people with recurrent gut infections.
The body is recommending that the procedure is offered to people who have been treated for two or more Clostridium difficile (C diff) infections without success. This infection is sometimes referred to as a ‘superbug’, as it can be so resistant to treatment. It’s thought that the move could ease the symptoms of between 450-500 people in England each year.
Clinical trial evidence, said NICE in a press release, showed that this treatment is significantly better than antibiotics alone at resolving a C. diff infection in people who have had two or more previous infections.
What is a Faecal Microbiota Transplant?
Faecal microbiota transplants have been used in mainstream medicine for many years. They involve the transplant of faecal matter from a healthy person into the large intestine of someone who is struggling with their gut health. The idea is to restore a healthy balance of the microbiota – the collection of organisms that live in your gut – by bringing in more ‘good’ bacteria.
Previous evidence has suggested that a FMT for this infection has a success rate of up to 90%.
What is a Clostridium difficile (C-diff) infection?
FMTs are being offered to treat stubborn Clostridium difficile (C-diff) infections. C-diff is a type of bacteria that causes infections when the balance of bacteria in the gut changes, causing fever, diarrhoea, cramping and nausea. It can be extremely severe, and can cause a loss of fluids so dramatic it could be fatal.
You're more likely to incur this infection if you have a weakened immune system, which could be the case if you have a long term health condition or are over 65. It’s also more likely in people who have taken antibiotics recently.
Usually, C-diff infections are treated with antibiotics and clear up within 1 to 2 weeks, but they can sometimes become resistant to this treatment – which is where FMTs come in.
So how do Faecal Microbiota Transplants work?
FMTs allow healthy bacteria from a donor’s gut to be transferred into the recipient’s gut, via the former's stool sample. Now this might sound messier than your end-of-summer Saturday night out, but trust that it's a tightly controlled procedure.
The stool donor can be someone the recipient knows, or selected from a bank of pre-approved donors. Either way, they will always be thoroughly screened before their poo is used, to make sure they won’t pass on anything troublesome.
The transplanted substance that gets put into the recipient's gut consists of bacteria from the donor's poo dissolved in a saline solution, which can then be placed into the recipient via one of three methods: through a colonoscopy, a capsule that the recipient swallows, or a tube to the stomach inserted through the nose.
What else does NICE say?
Of the move, Mark Chapman, interim director of Medical Technology at NICE, said: ‘There is currently a need for an effective treatment of C. diff in people who have had two or more rounds of antibiotics.
‘Our committee’s recommendation of this innovative treatment will provide another tool for health professionals to use in the fight against this infection, while at the same time balancing the need to offer the best care with value for money.
‘Use of this treatment will also help reduce the reliance on antibiotics and in turn reduce the chances of antimicrobial resistance, which supports NICE’s guidance on good antimicrobial stewardship.’
