Human stool treatment upends race to treat colon germ

Drugmakers racing to develop medicines and vaccines to combat a germ that ravages the gut and kills thousands have a new challenger: the human stool.

For patients hit hardest by the bacterium Clostridium difficile, getting a "stool transplant" could become a standard treatment within just a few years. Just as blood banks and sperm banks are now commonplace, stool banks may soon dot the landscape.

About 3 million Americans are infected annually with the bacterium - also known as C. diff - which spreads mainly through hospitals, nursing homes and doctors' offices.

Most people have no symptoms, but 500,000 - more than half of them 65 and older - develop abdominal cramps, fever, diarrhea and inflamed colons. As many as 30,000 Americans die each year from the bacterium, usually after recurrences of infection.

The infections are typically the result of taking antibiotics, which wipe out friendly bacteria in the colon that normally keep C. diff under control. Transplants of stool from screened donors - given by enema, colonoscopy or a tube down the throat - restore these bacteria.

Although the vast majority of C. diff infections occur in healthcare settings, more and more cases are occurring in younger adults and children who have not recently taken antibiotics or been hospitalized. They include people who take proton pump inhibitors - a leading class of heartburn drugs.

Costly treatments from Merck & Co and other drugmakers, and a vaccine from Sanofi, are on the horizon. But growing numbers of gastroenterologists are more excited about the use of human stool transplants, which in experimental settings have consistently cured 85 percent to 90 percent of patients who have had multiple episodes of C. diff.

"Until recently, fecal transplants have been on the fringes of mainstream medicine," said Dr. Cliff McDonald, an epidemiologist with the U.S. Centers for Disease Control and Prevention (CDC). "It could become the primary mode of therapy within a year or two for patients with multiple recurrences."

Francie Williamson, a 32-year-old editor for the Cedar Rapids Gazette in Iowa, has been battling C. diff since giving birth in May and considers herself a prime candidate.

After several recurrences, she still suffers from cramping and diarrhea and is making another appointment with her doctor to see if she still has the germ.

"He's done fecal transplants, like 10 of them. So I definitely want to have (that option) in my back pocket."

WHEEL OF MISFORTUNE

The first recorded stool transplants were given in 1958 to four patients with inflamed colons. The procedures won more attention in the mid-1980s, when Australian gastroenterologist Thomas Borody began using them to treat his C. diff. patients.