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IBS, colitis and Clostridium difficile

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Clostridium difficile is in all of us. However, when the diversity of gut bacteria is reduced (and especially levels of ‘friendly’ good bacteria, it can overpower the system. This can cause IBS a severely debilitating disease.

A decade ago a more virulent strain of C. difficile emerged that can attack individuals after just one routine course of antibiotics. Cases have tripled since that time. This new strain produces up to 23 times more of the disease’s primary toxins than the common version. Like most strains of C-difficile, it also produces heat resistant spores that can persist and lead to relapse.

The need for a better treatment is great and urgent. Up to 20 percent of infected patients suffer at least one recurrence; 35 percent of those go on to have a second; and 65 percent of those are likely to have even more. A few sufferers actually have their infected colon removed in order to “cure” the disease.

In 2012, there were over 500,000 cases of excessive C-difficile in patients treated in hospitals in America and 14,000 deaths. The bacterium spreads very easily.

In the 1980s, an Australian doctor, Thomas Borody, suggested that one way to cure patients might be a faecal transplant.

The idea is something vets working on farms have known about for a long time. There was even reference to treating humans in America as long ago as 1958. The goal is to restore the ideal natural balance of intestinal flora and over- power the C. difficile bad boys.

In 2008, a double blind clinical trial commenced. One of the trial designers was Dr. Colleen Kelly, a gastroenterologist in Providence, Rhode Island. She first treated a patient with a faecal transplant in 2008. The patient was completely debilitated after six painful months of C. difficile colitis. “I tried every standard regimen of treatment. Nothing worked,” Kelly says. After the patient received a transplant of her live-in boyfriend’s stool, she was completely cured. Kelly had done more than 100 treatments by the start of the trial. According to the New England Journal of Medicine, the trial was a success with transplants beating the best antibiotic for returning patients to health. 43 patients were treated. 13 out of the 16 receiving the transplant saw their illness disappear immediately, compared with only four out of 13 in the antibiotic-only group, and three out of 13 in the antibiotic plus transplant group.

As always with these ‘natural beats drugs’ results, some ‘experts’ immediately talk about developing expensive pills (which will have to be approved by the FDA as drugs) instead of using the research results and simple enemas. First, you take healthy stools, remove the food and the waste and then give people just the active bacteria in a pill form. The pill is ‘guaranteed’ to reach its destination and work. University of Calgary researchers reported a 100 percent success rate – none of the 27 patients who took the tablet-sized pills had a recurrence of C. difficile, even though all of them previously had had at least four bouts of the infection. Patients ingested between 24 and 34 capsules containing faecal bacteria, often donated by family members. “Patients with C. difficile often have 20 or more stools a day, which seriously affects quality of life and so they are very open to this treatment,” said Ravi Kamepalli, MD, an infectious diseases physician at the Regional Infectious Disease-Infusion Center, Lima, Ohio, and lead author of the study. “Human beings are 90 percent bacteria and once that balance is altered with antibiotics, opportunistic infections can cause serious problems. All we are doing with this treatment is resetting the balance.”