A clinical trial led by doctors and researchers in Alberta has found that fecal transplants delivered orally by capsule may be just as effective as transplants done by colonoscopy in treating C. difficile infections.
The findings, published Tuesday in the Journal of the American Medical Association, found that capsules containing frozen donor bacteria were 96 per cent effective in treating C. difficile, a bacterial infection that can cause diarrhea and, in serious cases, life-threatening inflammation of the colon.
The patients who received the capsule treatment had the same success rate as those receiving fecal transplant by colonoscopy.
C. difficile infections are common among older people in hospitals or nursing homes, and they sometimes don’t respond to antibiotic treatments.
However, doctors have reported great success rates when treating C. difficile patients with fecal microbiota transplants, or FMTs. The process involves transplanting the stool of healthy patients into the intestines of patients with hard-to-treat infections, like C. diff. The fecal transplants work by re-introducing healthy gut bacteria into the patient’s system.
The Alberta researchers say FMTs delivered by capsule could revolutionize the treatment of C. diff and other intestinal infections.
“It is more convenient, it is cheaper and it is safer for the patients to receive the capsules than the traditional ways of receiving the (fecal) transplants,” Dr. Dina Kao, the study’s lead author, and an Alberta Health Services gastroenterologist, told CTV News.
“Patients come back to tell me that they often feel almost immediately different the day of the procedure,” she said. “They just feel the surge of energy come back and their appetites come back and they just feel very different. It is just like a light switch has turned on for them again.”
The researchers estimate that the use of FMT capsules would likely save the health system a minimum of $1,000 per patient.
The clinical trial divided 116 patients with recurrent C. difficile infections into two groups. One group received the capsule treatment, while the other received stool transplants by colonoscopy.
More patients who took the capsules rated their experience as “not at all unpleasant,” the study says. The capsules don’t contain actual feces, just the microbes present in the stool collected from donors.
Karen Shandro, one of the patients who took the capsules, said she had a “debilitating” C. difficile infection for two months before the treatment.
“Having C. diff is indescribable,” the Ardrossan, Alta. woman told CTV News. She said constant diarrhea left her weak and “trapped” in her home.
Shandro said she “basically camped out in her bedroom and bathroom” with excruciating pain caused by the infection.
As part of the clinical trial, she had to take 59 FMT capsules, but said she felt better immediately.
“It is indescribable. It was literally within two days that I felt normal,” she said.
Infectious diseases expert Dr. Tom Louie, who pioneered the use of fecal transplants for C. difficile in Canada and developed the FMT pills, said the latest study is “verification” of the capsules’ effectiveness.
“These fecal capsules are a convenient way of restoring the gut microbiome,” the Calgary doctor told CTV News.
While “there’s probably a small of degree of ‘ick’” initially, all patients who took the FMT pills were “immediately quite accepting,” Dr. Louie said.
“They can have their lives back in a flash.”
Other doctors see the pills as having an enormous potential to treat illnesses like Crohn’s disease.
“If we are to treat Crohn's disease with FMT then we will need this technology to deliver enough ‘healthy stool’ over a long enough time frame to the inflamed area,” Dr. Paul Moayyedi, the director of the gastroenterology division at McMaster University’s department of medicine, said.
Doctors in Edmonton have just started testing the pills for Crohn's disease, and McMaster University’s medical centre in Hamilton, Ont., is also expected to begin recruiting patients.
With a report from CTV’s medical affairs specialist Avis Favaro and Elizabeth St. Philip