RDS Infusions is a gastroenterology clinic that assists patients with Fecal Microbiota Transplantation (FMT). R. David Shepard, MD. Is the head of RDS Infusions. He is Board Certified in Gastroenterology and has been practicing in Tampa, Florida, USA for 25 years specializing in Inflammatory Bowel Disease.
What kinds of patients does your clinic see?
Our clinic treats patients with C. Diff, UC, Crohns, IBS, Heartburn, Liver Disease, and Pancreatitis. FMT comprises 20% of the practice and is increasing. We use FMT for the treatment of drug resistant C. diff.
** This interview predates the change in regulations regarding FMT only for C. diff. They now have a probiotic RDS infusion with bacteria from the colon for conditions such as ulcerative colitis, IBS, and chronic diarrhea.
How long have you been doing FMTs and how many have you done?
We’ve assisted with more than 100 FMTs over a two-year period. C. diff. and UC make up the vast majority of our FMT patients.
** This interview predates the change in regulations regarding FMT only for C. diff. The clinic now offers RDS infusions of probiotics derived from the colon for UC.
What kind of successes and non-successes have you seen with FMT?
We’ve had excellent results with C. diff. and UC. Our success rate for the treatment of C. diff. is nearly 100% and for ulcerative colitis it is in the range of 70 to 80%. We’ve also seen IBS-D predominant patients reduce their diarrhea significantly. The use of FMT to treat Crohn’s patients has been disappointing.
We’ve assisted patients with FMT to tackle conditions such as MS and constipation, but the numbers are too small and it’s too early to know if its will be successful. We’ve also received enquiries regarding Autism, Parkinson’s disease and obesity.
What has been your most striking success?
The most striking success has been a young woman with UC. She was at university and quite debilitated by the disease, which was causing social issues. She has now been in remission for two years after receiving only one FMT from her mother. She has gone from 15 bloody bowel movements daily to one or two normal BMs. Her father reports the treatment has been “life-changing.”
We’ve successfully treated a 60-year-old man who had been on and off antibiotics for C. Diff for 9 months. He couldn’t sleep; he was underweight, ashen and gray. When I met him he’d been hospitalized on multiple occasions. He said to me: “If you can’t cure this I want to die.” Yet he achieved remission after a mere two FMT treatments, and is still well six months later.
These kinds of success stories keep us going.
What kind of donors work better?
We like to use donors who have previously been successful with other patients. We like our donors aged 20-50, free of antibiotics for six months, and ideally medication and gluten free.
Do you do FMT Top-down or Bottom-up?
Both. Some resistant cases of C. dif. and UC require top-down via gastroscope infusion.
Does Top-Down aggravate SIBO?
We have not experienced this yet.
Have you used Frozen FMT?
Yes, we’ve seen good results from frozen FMT. We freeze it in a small cylinder, then cut it in small pieces to fit in a capsule.
What is your view on antibiotics prior to FMT?
We feel it is important to reduce bacteria in the gut before infusing. That’s with first infusion only. After you’ve done FMT it is very important to avoid them.
How long should a patient continue FMT?
C. diff. generally only requires one or two treatments. UC needs more depending on the individual. We recommend to gradually decrease to weekly, then monthly over a couple of years until a normal colonoscopy is achieved.
How long should medications be continued once symptoms subside?
We try to slowly wean the medications. Everyone is different. Not everyone with UC can completely come off of all medications.
Is it ok to do FMT during a flare?
During a mild flare it’s ok. But with a severe flare we prefer to control it with a short course of steroids.
Where FMT doesn’t work in a patient or only works for a while, what factors do you believe perpetuate the dysbiosis?
With UC it can be the severity of the disease, or the FMT comes onboard too late and too much damage has been done. Unfortunately with UC, some people seem genetically programmed to lose their colons and there is nothing we can do to help.
What side effects have you observed from FMT?
Bloating is the only side effect I’ve seen to date.
What do you see as the risks of FMT?
The biggest risk I see is from untested donors. I had a patient who did home FMT and picked up a parasite from his spouse. She was very healthy and had no outward symptoms of infection. We had to treat both of them before starting the FMT again.
This is why we offer a supervised self-infusion protocol. Desperate patients will do FMT anyway regardless of the FDA. It is better that we offer the testing with advice on how to do FMT safely.
What do you think about the potential long-term risks of FMT?
FT has been used since 1958 without any documented serious side effects. However, more research needs to be done.
Why is the mainstream medical profession so dismissive of FMT? Given the success with C. diff. what’s wrong with trying it for more difficult chronic gut conditions? Where’s the harm?
No. 1 deterrent is the “gross factor.” Without question it’s the stigma.
No. 2 deterrent is the lack of controlled clinical trials. There is no incentive for pharmaceutical companies to fund them. In fact, Big Pharma will lose money if FMT becomes widely available. So that leaves the universities and not-for-profit sector and the reality is that it’s a huge investment and years before anyone will recoup any money, if ever.
No. 3 deterrent is patient resistance. Patients want a pill. Although once they’re really sick they don’t care.
Why don’t the insurance companies take on the research?
I suspect that it’s not on their radar compared to cancer, heart disease, etc. However, sooner or later they’ll have to pick up on this. It costs around $2,000 to have FMT compared to tens of thousands of dollars on treatments for C. diff. and IBD. One hospitalization can cost 20-30 thousand dollars, not to mention lost wages.
Do you know much about the fake poop being developed?
They sound like a fancy probiotic to me. Even with the best science we have identified only 20% of the bacteria in the gut. I have not seen any clinical trials on synthetic stool yet.
What research is on your wish list?
I would like to know if infant donors are as good as adults as they would be a safer option. I’d also like to know which stool filtration methods work best.
What have been some of the challenges of running a FMT practice?
Finding donors. Staff acceptability.
How has the recent FDA ruling affected your practice?
We’ve now stopped doing FMT except for C. Diff. For other conditions we have a protocol for patients to self-infuse under medical supervision. This is done in my office.
What’s the best way for patients to get assistance from you with FMT?
Visit our website at RDSInfusions.com.
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