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The Future of Feces

Fecal transplants are being heralded as a simple cure for a dangerous and growing intestinal infection. But their future is uncertain.



Jennifer spent the better part of 2009 in a hospital due to a stomach condition called gastroparesis. According to the Sacramento resident, that's where she contracted Clostridium difficile (C. diff for short), a nasty and potentially life-threatening bacterial infection that's often spread in health-care settings. She said it began with bloody diarrhea, and multiple courses of expensive antibiotics didn't help. After suffering with the affliction for years, Jennifer (whom the Express agreed to identify by her first name because of privacy concerns) was desperate to find a cure. "I was living on Imodium during the day because I didn't want to have problems at work," she said, adding that she lost several jobs as a result of her sickness.

The answer to her woes, it turns out, was feces.

A year and a half ago, Jennifer's mother began researching alternative solutions online. That's when she discovered Oakland gastroenterologist Dr. Neil Stollman.

For the past five years, Stollman, whose office is tucked inside the historic Rotunda building in Frank Ogawa Plaza, has been treating sufferers of C. diff with a procedure known as fecal microbiota transplantation. It involves taking a stool sample from a healthy donor (usually a spouse or relative, or someone the patient trusts) and mixing it with saline to create a "milkshake-like" consistency, which is then delivered via enema into the C. diff patient's gastrointestinal tract. (It can also be administered via colonoscopy or nose tube.) The bacteria in the donor's stool restore the patient's balance of healthy bacteria. According to studies, the procedure's effectiveness in treating severe or recurring C. diff is higher than 90 percent.

After a consultation with Stollman, Jennifer was deemed suitable for the procedure, and her mother was identified as a healthy donor. In the week leading up to it, Jennifer's mother ate prunes every night to regulate her bowel movements for stool donation.

The results of the fecal transplant were almost immediate. Within a week, Jennifer felt better. "Stools were normal. My lower abdomen cramps were gone. It was amazing," she said. After suffering from C. diff for four painful years, Jennifer said she has gained ten pounds and been able to return to work full-time. "I was sick for so long," said the veterinarian. "It was the best thing, really."

According to Stollman, of the approximately 75 patients he has treated, all have been cured — quickly and at a fraction of the cost of antibiotic treatment. The concept of fecal transplants dates back to the 4th century when people with food poisoning ingested feces as a treatment in China. They have also been popular among veterinarians, who have used them to treat diarrhea in large animals such as horses. But only recently has Western medicine embraced them as more studies (including ones by Stollman) have been published in scientific journals. In January, The New England Journal of Medicine published the first study showing the effectiveness of fecal transplants compared to standard antibiotic therapy in patients with severe or recurring C. diff. It showed transplants cured fifteen of sixteen people, whereas antibiotics effectively treated three of thirteen people. Media outlets like The New York Times, WIRED, Gawker, and the radio program Radiolab picked up the story, touting the healing powers of poop.

It's possible that fecal transplants could help tens of thousands of patients, according to Stollman. In recent years, incidences of C. diff have become more frequent, severe, and difficult to treat. The infection is usually treated with antibiotics — Vancomycin being the most commonly prescribed — and while that method's initial success rate is higher than 90 percent, C. diff recurrence rates range from 15 to 35 percent. In a recently released report, the Centers for Disease Control and Prevention (CDC) stated that the threat level of C. diff infections is now considered "urgent." C. diff debilitates more than 250,000 Americans and kills an estimated 14,000 every year, costing at least $1 billion in medical expenses. Symptoms can include diarrhea, fever, loss of appetite, abdominal pain, and nausea. According to the CDC, people can become infected if they touch surfaces that are contaminated with feces that contain the bacteria and then touch their mouth or mucous membranes. The elderly and people who have illnesses that require prolonged use of antibiotics have a greater risk of acquiring C. diff, because antibiotics kill the gut bacteria required to fight the infection. It's often spread from health-care workers to patients and is classified as a "healthcare-associated infection."

Recently, more doctors have begun offering fecal transplants. Locally, Kaiser Permanente's Walnut Creek and Antioch Medical Centers have been treating C. diff patients with fecal transplants for the past year. Stanford Hospital and UCSF will also soon offer the treatment.

But demand has far outpaced availability. Until recently, Stollman was the only doctor in California to offer fecal transplants. Although no official data or registry exists, Stollman estimates that only about one hundred doctors in the United States offer the procedure, citing the fact that it is labor-intensive, potentially high-risk, and is poorly compensated (there is currently no billing code for fecal transplants, so how doctors bill for it varies, as does what health insurance companies agree to pay for, if anything).

Meanwhile, fecal transplants are increasingly being viewed as a "miracle cure." Stollman said his office fields hundreds of calls every month from people who want fecal transplants for everything from autism to acne. (Stollman said he only uses the treatment as a "last resort" for C. diff patients who have already tried multiple courses of antibiotics.) Meanwhile, clinics promising quick cures have begun sprouting up, aiming to capitalize on the newfound demand for poop. In a story published last year by the Portland alt-weekly Willamette Week, a fecal clinic promised to treat autoimmune diseases, eczema, asthma, multiple sclerosis, and depression — starting at $4,000 for a five-day "colon health retreat." The clinic's doctor said he was "self-taught."