Patients with bowel disease eager to test faecal therapy

A study published in the journal Inflammatory Bowel Disease is the first of its kind to look at the social and ethical issues around a therapy for ulcerative colitis dating back to 1958.

Faecal microbiota transplantation (FMT) has been used over the last 50-odd years as a last-ditch attempt to restore microbial balance for patients with severe intestinal infections. More recently the therapy has produced lasting remission for patients with ulcerative colitis. FMT involves finding a donor, often a family member, taking a fresh stool sample, mixing it with salt water and filtering out particulate matter. The solution is then administered either as an enema or via a naso-gastric tube for inflammation higher up in the gut.

Study author Dr David Rubin, associate professor of medicine at the University of Chicago and colleagues Dr Stacy Kahn and Dr Rita Gorawara-Bhat, organised six focus groups in 2009-2010 with patients or parents of children with ulcerative colitis to explore the attitudes and concerns relating to this therapy. The members of the study group viewed this therapy as more natural than most of the drugs used in treatment – with many comparing it to the already popular use of probiotics as treatment for colitis. 21 out of 22 patients said they would try FMT for themselves or their child.

The major concerns were how donors would be selected, for instance a donor who had eaten peanuts would be hazardous for a recipient with peanut allergy. Physicians recommended screening for multiple diseases as well as parasites and worms. The focus groups were also happy about the administration via enema or a spray colonoscopy, but were unenthusiastic about delivery via a naso-gastric tube.

The researchers found that not only were the focus group overwhelmingly supportive of the therapy and eager for it to become available, but also some had already tried the strategy at home using internet ‘protocols’ and tools from the drugstore. Rubin is hoping to be able to begin offering FMT this year in a controlled, clinical setting.

Source: Inflammatory Bowel Disease

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First Published in June 2011

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