Bondurant was doing well with the transplants until October 2014 when he acquired a bacterial infection during a trip to visit his uncle. The infection caused the ulcerative colitis to spiral out of control and he was eventually forced to have his colon removed. Despite what happened, the 56-year-old financial adviser has no regrets. “I believe the fecal transplants helped me keep my colon for two to three years longer than I ever could have,” says Bondurant. “In the past, we thought that feces made us sick and antibiotics cured us. Now we know that antibiotics can make us sick and feces can cure us.” Like Bondurant, a growing number of patients in the inflammatory bowel disease community have also taken matters into their own hands by experimenting with DIY fecal transplants. But is it safe? And more importantly, could transplanting someone else’s feces really be an effective treatment for ulcerative colitis? Fecal transplantation involves transferring stool from a healthy donor into the gastrointestinal tract of another person to help restore healthy gut microbes. The practice has been around since at least the late 1950s, when the first transplants were performed. While fecal transplants have yet to be approved by the Food and Drug Administration (FDA), the agency permits clinicians to perform them to treat recurrent C. difficile infections. “Fecal transplant is a very effective treatment for C. difficile when the beneficial bacteria normally in your colon have been wiped out by the illness and antibiotics,” says Matthew J. Hamilton, MD, a gastroenterologist at Brigham Women’s Hospital and an instructor at Harvard Medical School in Boston.
Treating Ulcerative Colitis With Fecal Transplants
Though Bondurant felt his DIY treatments were helpful, fecal transplants for ulcerative colitis are still in the investigational stage. Researchers are also looking into fecal transplant as a potential treatment for IBD and Crohn’s disease. And the results so far have been encouraging. A study published in January 2017 in the journal Inflammatory Bowel Diseases found that ulcerative colitis patients who received a combination of both antibiotics and fecal microbiota transplants (FMT) were able to re-establish healthy gut bacteria populations. Still, physicians caution that patients should not attempt to perform the procedure themselves. “I would not recommend anyone perform home FMT as there are many real and theoretical risks that should be discussed with an experienced practitioner before considering this therapy,” says Jessica R. Allegretti, MD, MPH, attending gastroenterologist at Brigham Women’s Hospital and an instructor of medicine at Harvard Medical School in Boston. Currently, doctors who wish to use FMT to treat patients for something other than C. difficile infections must do so as part of an FDA-authorized clinical trial. The FDA has also stated that FMT may only be tried as part of a clinical trial until more is known about whether the transplants can help diseases outside of recurrent Clostridium difficile, according to Alex Scheeler, regulatory affairs manager at OpenBiome, a nonprofit stool bank.
The Hidden Risks of DIY Fecal Transplants
In an article published in April 2014 in the World Journal of Gastroenterology, Dr. Hamilton and Dr. Allegretti issued a series of warnings about the do-it-yourself approach:
You could have a flare. Instead of improving IBD symptoms, some people seem to flare after a DIY fecal transplant.You could get an infection. In a clinical setting, stool samples go to a lab for screening before they are used in a fecal transplant. Blood is also tested for infection. There have been instances where people have done them on their own and transmitted infection.Standard doses aren’t established. With recurrent C. difficile, one or two transplants can be enough to cure the infection. IBD is more complicated because no one knows yet how often you will need treatments to keep symptoms controlled. Researchers also can’t predict how long healthy bacteria will remain active in patients with ulcerative colitis, according to a study published in October 2013 in The American Journal of Gastroenterology.Everyone’s IBD is different. Certain patients might already have an underlying infection or a severe form, where fecal transplantation might put them at higher risk for an infection.IBD treatments may conflict. Any medication you’re taking that suppresses the immune system could put you at increased risk for an infection caused by an unscreened fecal transplant.
While research is starting to shed light on the potential benefits of fecal transplantation for IBD, it’s not quite ready for prime time. But if you’re still interested, talk to the medical team helping you manage IBD about whether your condition, current medication, and overall health would make you a good candidate. You can also look into clinical trials where fecal transplantation is performed in a safe, controlled setting. Additional reporting by Tuan Nguyen
