The first study of the social and ethical issues associated with a provocative approach to treatment for ulcerative colitis has found that the majority of potential patients are eager for what is now called "fecal microbiota transplantation" to become available, although many have concerns about donor selection, screening, and methods of delivery.
Bacterial aggregates derived from fecal matter have been used sporadically to treat gastrointestinal disease for more than 50 years. These were often last-ditch efforts aimed at restoring microbial balance for patients with raging intestinal infections. More recently, the approach has produced lasting remissions for a small number of patients with a common disease: ulcerative colitis.
"Once patients get past the yuck factor they find the concept appealing," said study author David Rubin, MD, associate professor of medicine at the University of Chicago. "They perceive it as 'natural,' similar to probiotics. Patients with severe inflammatory bowel disease tend to develop a high tolerance for therapies that others might consider unorthodox."
Fecal microbiota transplantation (FMT)also known as fecal bacteriotherapy, among other namesis an effort to calm a troubled bowel by reintroducing the vast diversity of collaborative bowel inhabitants after the usual mix has been disturbed. More than 1,000 different strains of bacteria co-exist peacefully in the typical healthy bowel. But when the delicate balance is altered, by antibiotics or other causes, a few strains can become dominant, leading to severe diarrhea, inflammation and tissue damage.
The first FMT cases, dating back to 1958, were used to treat life-threatening infections caused by aggressive bacteria that had overwhelmed the bowel, driving out the competition. When antibiotics were unable to control the infection, physicians were able to restore balance by injecting the full range of gut bacteria. They did this by collecting fecal
|Contact: John Easton|
University of Chicago Medical Center