Stool Banks Provide Relief For C. Diff Sufferers
They're not as ubiquitous as blood or sperm banks, but another kind of biological substance also sits in cold storage ready to treat desperately ill or ailing patients. In Pittsburgh, the use of stool banks for fecal transplants is on the rise.
A fecal transplant is exactly what it sounds like.
“It is actually taking stool from a healthy donor and putting it into the colon, via a colonoscopy, of somebody who’s been having what we call refractory C. Diff Colitis,” said Meredith Wisniewski, chief physician assistant with the Allegheny Center for Digestive Health. “Which means they’ve taken antibiotics, (and) they are not clearing the infection. Therefore, this would be the next step.”
She said the healthy stool re-populates the gut with healthy bacteria, allowing the Clostridium difficile infection, or more commonly, C. Diff, to clear.
Before stool banks, patients would have to find a stool donor on their own; it could be a family member or close friend. The donor would then undergo several tests to ensure their stool was healthy enough for use. That process can cost the patient a minimum of $500 and, more typically, $1,500 or more.
Allegheny Health Network recently started working with a stool bank in Massachusetts to acquire stool samples.
“They have a pool of donors that they’re constantly screening,” Wisniewski said. “These are people who periodically donate their stool, the stool samples themselves are also cultured and screened.”
Going through a stool bank can save the patient money and time – which can be critical when trying to fight off a debilitating illness.
Living With C. Diff
Heather Newlin knows how difficult it is to live with C. Diff, which can also be life-threatening.
“You can’t stop going to the bathroom at all,” Newlin said. “And there’s a very distinct look and smell – I mean, like, I will never forget the experience. I mean, it’s basically your insides coming out. It’s just horrible.”
Newlin became infected with C. Diff after giving birth to her son at UPMC Magee-Women’s Hospital.
At the time, the Point Breeze resident said doctors weren’t sure what was wrong. When doctors at UPMC Presbyterian Hospital finally gave her a correct diagnosis, she started with an antibiotic treatment. But it wasn’t enough to eliminate the C. Diff.
“And that’s when I started looking into fecal matter transplants,” Newlin said. “Because I didn’t know how I’d ever get rid of this.”
Newlin got lucky, though. Her infection cleared before she went through with a transplant.
Others aren’t as fortunate.
Transplants On The Rise
AHN doctors have averaged about 10 fecal transplants every year for the past five, but that number is expected to more than double this year. UPMC physicians perform about 30 per year, and they, too, expect demand to rise.
That’s partly because of advances in diagnosing C. Diff and increased awareness.
“Ten years ago it was pretty uncommon,” UPMC gastroenterologist Marc Schwartz said. “Unfortunately, Pittsburgh was one of the places where it became epidemic, a little over 10 years ago, and really started to make a big splash.”
It’s unclear why C. Diff increased in the region, according to Schwartz. The National Institutes of Health reports its spread could be partially blamed on a more virulent strain of C. Diff that is resistant to antibiotics. That’s when fecal transplants can be most beneficial.
“It’s highly effective,” Wisniewski said. “Typically, most patients will see a dramatic reduction in symptoms right away.”
And fecal transplants work more than 90 percent of the time, according to both Wisniewski and Schwartz.
An Old Treatment
The concept of a fecal transplant isn't new. Some physicians performed fecal transplants for decades and they have been used in animals for more than 100 years, according to the NIH. So, why aren’t they more widely done? And why aren’t they done before antibiotics?
“It’s not approved by the FDA,” Schwartz said. “It is allowed by the FDA.”
The U.S. Food and Drug Administration drafted guidelines that outline how and when fecal transplants can be used. C. Diff is currently the only diagnosis for which doctors are currently allowed to administer them.
“It’s not a medicine and it’s not a medical device – it’s somewhere in between,” Schwartz said. “And the problem is that every fecal transplant, if it’s done from a donor, is technically different material.”
The FDA also frowns on stool banks, Schwartz said.
“Their concern is, since these stool banks may have, like, five or 10 donors, that then provide thousands of doses,” Schwartz said. “If one of those donors had false negative testing and actually had a communicable disease, one person could expose 1,000 people.”
Stool Bank Use
Pittsburgh medical providers are among the 556 hospitals nationwide that use samples from Massachusetts-based OpenBiome, which claims to rigorously test donors' blood and stool. They also offer donors an added incentive: $40 per sample.
Schwartz said the stool bank business model makes sense. It allows companies to supply thousands of healthy stool samples to patients across the U.S.
The FDA issued guidelines, he said, not hard and fast rules.
Though fecal transplants are currently only allowed for C. Diff patients, that’s expected to change.
“Actually there (are) lots of studies ongoing regarding fecal transplants,” Wisniewski said. “Not just for Inflammatory Bowel Disease, but other sorts of disorders as well. There’s even research regarding obesity and how the bacteria in our guts plays a role in the development of obesity.”
In addition to a colonoscopy, fecal transplants can be performed through a tube down the nose or throat or taken in pill form. And while the latter options can sound a bit off-putting for some people, Wisniewski said it’s not such an issue for many patients.
“You know, really and truly, by the time patients kind of get to the point where they’ve been dealing with these symptoms for a while, it really isn’t a factor,” Wisniewski said.
“I was ready,” she said. “I would have eaten it with a knife and fork.”
Health care coverage on 90.5 WESA is made possible, in part, by a grant from Pittsburgh's Jewish Healthcare Foundation.