The major concerns were focused on how donors would be selected and screened. Patients wanted healthy donors, usually family members, and asked that even their diet and medications be considered. A donor who had eaten peanuts recently, for example could be hazardous for a recipient with peanut allergies.
Physicians recommend a workup similar to that of an organ donor, with careful screening for multiple pathogens, including HIV, hepatitis and other viruses, as well as various parasites and worms.
The "yuck" factor came up in the focus group discussions of bacterial delivery. Patients and parent were comfortable with the idea of a "spray" colonoscopy or delivery via enemas, but were disturbed by the idea of using a naso-gastric tube for the transfer of fecal bacteria, although this method has been used to treat Clostridium difficile infections.
"What our study ultimately tells us is that patients are not only tolerant of this therapy but are eager for it to become available," Rubin said. "A few have already tried this strategy at home, using 'protocols' they found on the internet and tools available at any drug store."
"We hope to begin offering FMT this fall," he said, "in a carefully controlled, clinical-trial setting."
"We are getting at least one phone call a week from patients asking about the treatment and when we are going to start treating patients," said co-author Stacy Kahn, MD, instructor of pediatrics at the University of Chicago.
There are many things we do not yet know about the risks and benefits of FMT, the authors agreed. The safety of such a treatment and broader implications of risk remain unconfirmed, so careful preparation and more study is necessary before this can be offered to patients with ulcerative colitis.
"Many patients do benefit from proven traditional therapies," Rubin said, "which should always be considered before experime
|Contact: John Easton|
University of Chicago Medical Center