Dr Gary H. Hoffman on FMT for C. diff

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Dr Gary H Hoffman talks about fecal transplant


The following guest post is written by Dr. Gary H. Hoffman, a board certified surgeon of Los Angeles Colon And Rectal Surgical Associates.  Dr. Hoffman has experience with fecal microbial transplantation and is attuned to the nuances of c. diff colitis and its treatments.  The surgeons of LAcolon.com work closely with referring doctors and infectious disease specialists to individualize the evaluation and treatment of patients with resistant C. Diff.

Fecal Microbial Transplantation.  Time To Call A Specialist.

The final part of the gastrointestinal tract involved in handling our waste is the colon.  The colon serves as a storage area and a place where excess water can be resorbed into the body.  Although remarkably resistant to infections given the large number of bacteria inhabiting the colon, occasionally an infection with a virulent bacteria known as Clostridium Difficile (also know as C. Diff.) may occur.  If this infection, C. Diff., does not respond to antibiotics, a technique known as fecal microbial transplantation (FMT for short) must be used.  Fecal microbial transplantation, performed by a specialist known as a colon and rectal surgeon, or proctologist, reintroduces normal bacteria into the colon, and this normal bacteria replaces the abnormal bacteria such as c. diff.

Fecal microbial transplantation is a relatively new procedure, and has been developed in an effort to combat the growing problem of antibiotic-resistant strains of bacteria beginning to inhabit humans on a worldwide basis.  Because of increasing ease of worldwide travel, these resistant strains have moved around the globe.  Some bacteria may cause an infection and inflammation of the colon, known as colitis.  When a patient develops c. diff, colitis, strong antibiotics are needed to combat this inflammatory condition.  However, c. diff. is becoming increasingly immune to the drugs used to treat it.  This is where fecal microbial transplantation is needed.

In the United States, FMT is only performed by physicians.  Colon and rectal surgeons have been trained to diagnose resistant cases of C. Diff. They are also trained in FMT.  Equally important, much thought, planning and technical expertise are used in what may appear to be an easy procedure.  In other words, do not try FMT at home.

Fecal Microbial Transplantation for Clostridium Difficile (C. Diff)

Drugs used to treat clostridium difficile colitis include metronidazole and vancomycin.  Increasingly, C. Diff is becoming resistant to both of these drugs.  The theory underlying fecal microbial transplantation is simple: replace the pathogenic, resistant bacteria with healthy bacteria from a healthy donor.  How is this done?

The first, most important step in the treatment is to find a specialist familiar with both the disease and the treatment.  Surgeons who perform fecal microbial transplantation are few and far between.  Once you have found an FMT a physician, you will be asked a thorough list of questions evaluating your health, your travel, your contacts and your symptoms.  Past failed treatments protocols will be discussed.  Stool cultures may be taken to establish the correct diagnosis.  At this point, if you are a candidate for fecal microbial transplantation, you will be asked to find a healthy stool donor.  The donor does not need to be a relative.  As long as your donor is healthy and willing to give a stool sample, anyone may donate and testing of the donor stool begins.  Infectious diseases are ruled out and the donor stool is tested for clostridium difficile as well.  If you are unable to find a suitable donor, a pre-screened, healthy stool sample may be purchased from a laboratory, specialized in this area of treatment.

Once the stool is obtained, you will undergo a standard colonoscopy.  Colonoscopy is a test normally used to screen the colon for polyps and tumors.  It is usually performed on patients over the age of 50 as a cancer screen.  You will be asked to clean your colon by drinking clear liquids and then taking a strong laxative.  On the morning of your procedure, you will receive a mild anesthetic to allow you to sleep while your surgeon performs the colonoscopy.  At this time, the donor stool will be placed into your colon and “sprayed” along your colon wall.  The entire procedure may last only a few minutes.  You will be awakened and allowed to return home shortly thereafter.

Does Fecal Microbial Transplantation Really Work?

The short answer is a resounding YES.  Up to 98% of cases of c. diff colitis are cured by fecal microbial transplantation.  Rarely, two treatment sessions are required.  Patients report a cessation of symptoms such as diarrhea or abdominal bloating, almost immediately.  Treatment is gratifying for both the physician and the patient.

FMT Treatment for Other Medical Conditions

Using FMT as a treatment for Clostridium Difficile colitis has become a therapy that is now endorsed by the medical community.  However, many patients have turned to FMT as an alternative form of treatment for diseases other than c. diff. colitis, such as various autoimmune diseases.  The medical community prides itself on using proven therapies whose success and safety are based on evidence-based studies.  Hence, patients looking for support for the use of FMT in various conditions other than c. diff colitis, must turn to non-medical sources for education and support.  And, these patients run the risks of using improperly tested stool administered in the home setting.  While these patients are desperate for help, they may inadvertently worsen their conditions, or develop new conditions caused by the unsupervised use of FMT.  Few medical doctors are willing to participate in clinical fecal transplants for other, unstudied and unapproved diagnoses, and alternative uses for FMT cannot be recommended.  Wider use of FMT awaits the study and confirmation from large, supervised randomized clinical trials.

What to do next?

The most important first step is to schedule a confidential appointment with your colorectal surgeon to gather more information.  They will provide you with additional information about your treatment options as well as answer any questions you may have.

The LA Colon Team

The LA Colon Team


Other Articles / Interviews with FMT Practitioners

Interview with Dr David Shepard MD  (USA)

Interview with Dr Mark Davis ND  (USA)

Interview with Taymount Clinic’s Glenn Taylor  (UK)

Dr Arnab Ray MD on How to Talk to Your Doctor about FMT  (USA)

Interview with Dr Silvo Najt (Argentina)


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