How faecal transplants work

Faecal transplants are already being used to treat gut infections, could they also help with chronic illnesses?

Health Agenda magazine
January 2018

The very idea of a faecal transplant – relocating faeces from one person’s body to another – might seem gross. 

But people who’ve benefited from a faecal microbiota transplantation find its effectiveness in treating a range of chronic illnesses has overcome the ‘gross factor’. 

How it works

A stool (for example, about 50–75g) is transferred from a healthy donor into the bowel of a sick recipient, via enema or a tube that goes into the small intestine.

The healthy micro-organisms can then build the patient’s resistance to unhealthy bacteria and ideally restore the balance of their microbiome (the unique collection of microbial communities within our body).

Gut regeneration

FMT is now an option for people who test positive to Clostridium difficile, a bacteria which frequently causes diarrhoea in people who’ve taken antibiotics or been in hospital.

While Australian doctors don’t routinely test for the bacteria, data from the Netherlands showed that when doctors did test for it, they found it in about 40% of stool samples of people with diarrhoea.

American data shows that Clostridium difficile can be a serious health hazard: around 500,000 people are infected with the bacteria in the US each year and 29,000 people die within 30 days of initial diagnosis of it. Of these deaths, it was estimated about 15,000 were directly as a result of Clostridium difficile, according to the US Centers for Disease Control and Prevention.

Faecal transplants have helped many patients. “A single infusion of donor flora results in 90% being cured, while 2 infusions result in a cure rate closer to 99%,” says Professor Thomas Borody, medical director and gastroenterologist at The Centre for Digestive Diseases in Sydney.

“The results are often quite spectacular with diarrhoea incidents of up to 15–20 per day becoming 2 to 3 per day within 24 hours of treatment.”

The wider potential

Prof Borody says there’s an ever-growing list of conditions that have shown sporadic, single-case responses to faecal transplants, documented across various medical journals.

“There are numerous prospective trials in different conditions.” These include neurological conditions such as multiple sclerosis and epilepsy, and autoimmune conditions such as rheumatoid arthritis and alopecia totalis (hair loss).

Research into the interplay between the gut and our brain is very new, but it’s thought that some mental health issues might be driven by gut micro-organisms – and that faecal transplants could help.

Not a cure-all                                                 

While research into the use of faecal transplants as a treatment for a range of conditions is encouraging, Prof Borody cautions against viewing it as a cure-all remedy.

“Always consult experienced gastroenterologists in clinics that have done hundreds of such treatments and formal trials,” he warns.

“They can best explain which conditions faecal transplants can achieve cure or marked improvement [with], and in which cases it’s rare or unlikely to work.”