Sounds gross, works great: Fecal transplants cure nasty C.
After 52 years of marriage, Pat Shoop thought she'd shared every intimacy
possible with her husband, Bob.
But that was before she became so ill with a Clostridium difficile infection
last year that doctors suggested that a spousal stool transplant -- yes, a dose
of Bob’s feces -- might be the only way to save her life.
“I'd heard of intercourse, but I'd never heard of 'pooper-course,'"
Shoop, 75, of Minnetonka, Minn., jokes now. At the time, though, there was
nothing funny about it.
“I was so sick, I didn’t care," she recalled. "It feels like
the worst case of flu you could possibly, possibly have.”
Shoop, a longtime schoolteacher, was suffering from recurrent C. diff
infection, a potentially life-threatening bacterial illness that causes severe
diarrhea, abdominal pain, nausea and vomiting. It comes back again and again,
resisting most treatments, except, as it turns out, an infusion of stool from a
A new review of more than two dozen scientific reports involving 317
patients, some dating back 50 years, finds that fecal bacteriotherapy, commonly
known as fecal transplant, cured the problem in 92 percent of the cases. Nearly
all got better after just one treatment. That's a better record than other
treatments, including probiotics, toxin-binding molecules and an experimental
The review offers the most comprehensive evidence so far in favor of the
repugnant-sounding practice in which stool from a healthy donor is emulsified,
usually mixed with water or saline, and transferred via a nasal tube or enema to
the gut of a seriously ill C. diff patient.
“It’s considered a treatment of last resort,” said Amee R. Manges, an
epidemiologist at McGill University in Montreal, Canada, who led the review
published in the most recent issue of the journal Clinical Infectious Diseases.
Once transplanted, the healthy fecal bacteria help restore balance to the
patient’s bowels. C. diff infections typically develop after the intestinal
flora is disturbed, usually by overuse of certain antibiotics. For most of the
last decade, fecal transplants have been regarded as something of a fringe
treatment by outsiders, but as a viable treatment by doctors who see desperate
C. diff patients every day.
"It validates what we've thought all along," said Dr. Tim Rubin, a
gastroenterologist with Essentia Health in Duluth, Minn., whose team performed
its 119th fecal transplant last week. "We quote people a success rate of
about 90 percent."
Shoop, who was diagnosed in May 2010, believes she contracted the infection
either while in a nursing home for a broken arm or in a hospital for breast
cancer treatment. Rates of C. diff acquired in health care settings have
skyrocketed in recent years, climbing more than 200 percent in people older than
65 between 1996 and 2009, according to the Centers for Disease Control and
Prevention. Between 20 percent and 50 percent of those patients may wind up with
hard-to-treat recurrent infections, Rubin said.
For Shoop, getting an appointment with Dr. Rubin was a godsend. She and her
husband stayed at a nearby hotel, where Bob, 77, was under pressure to produce a
usable stool sample within 15 minutes of her scheduled appointment.
“We gave him chocolate, we gave him wine, we gave him steak,” she said.
Bob complied and the pair rushed to the clinic, where Dr. Rubin snaked a tube
through Shoop’s nose and into her stomach.
“It was 20 minutes,” she said. “He told me, ‘You’re not going to
taste it, you’re not going to smell it.’” And she didn’t.
That was on a Thursday. By Sunday afternoon, Shoop was better. Nearly a year
later, she says she still feels fine. Her health is so much improved, in fact,
that Shoop has become an ambassador of sorts for fecal transplant, sharing her
story with anyone who raises the specter of C. diff.
“I tell them I know of a procedure that works,” said Shoop, who believes
she would have died without it.