It may sound like a tough pill to swallow, but capsules filled with the refined fecal matter of healthy donors are both tasteless and odorless, and they allow patients battling severe C. difficile infections to avoid a colonoscopy.
C. difficile is a type of bacteria that is found everywhere, from soil and water to contaminated foods and surfaces. It can even be found in the intestines of many people who show no symptoms, and in most healthy people it doesn’t pose much of a threat. That’s because a healthy gut contains 100 trillion bacterial cells and up to 2,000 different kinds of bacteria, and these healthy microbes usually keep infectious bacteria at bay.
However, in patients who are being treated with antibiotics for other infections, many healthy gut bacteria can also be wiped out. And without competition, small numbers of harmful bacteria like C. difficile can quickly multiply and establish an infection, producing toxins that cause diarrhea, loss of appetite, and painful inflammation. Severe cases can be fatal, and treatment with even stronger antibiotics results in recurring infections in 20 percent of cases.
This is where the idea of fecal transplants comes in: by using a healthy stool sample to repopulate the gut with healthy bacteria, C. difficile is easily overtaken. Delivered by colonoscopy, it’s a cure 96 percent of the time.
But according to a clinical trial at the University of Alberta, the exact same success rate can be achieved by swallowing capsules taken orally.
The capsules are prepared by isolating and freezing the microbes from healthy stool samples. This means that they don’t contain actual feces, but they can repopulate the gut with healthy bacteria in the same way.
From a healthcare and economic standpoint, the pills are a clear winner. They avoid sedation and the risks of puncturing the intestine during a colonoscopy. They would also save $1,000 per patient.
What is perhaps more remarkable is that even from the patient’s point of view, the pills are the preferred choice. To get the amount of bacteria needed for treatment, participants needed to swallow up to 40 capsules in an hour, which is a tall ask for such sick, and oftentimes elderly, patients. Even so, 66 percent of patients rated them “not at all unpleasant,” versus only 44 percent of patients who received the transplant via colonoscopy.
Patients in the capsule group reported surges of energy and appetite returning overnight, with an almost complete return to feeling well within days.
More research is already underway to assess the capsule approach to fecal transplant for chronic gut inflammation diseases, like Crohn’s disease. The University of Alberta will be teaming up with researchers at the University of Calgary and McMaster University, and their clinical trial is recruiting patients now.