Monday, 6 May 2013

Poo, glorious poo

C. diff. Courtesy of Marcus007 at de.wikipedia [Public domain], from Wikimedia Commons
 When is it medically advisable to eat some one else's poo? When you need a poo transplant.
Poo transplants could be the solution to one of the biggest problems facing the NHS today- the bacterial infection Clostridium difficile. C.diff, as its known to its friends, infects about 18,000 people in England and Wales every year and is involved in the deaths of about 2000 people.
C.diff typically arises due to imbalances in your normal gut bacteria. You see your gut is like a city, a city with about 100 trillion bacterial residents happily munching away on a banquet of bowel contents. The average person has about 1000 different types of bacteria in their gut, and about 3% of healthy adults have C.diff in that mix. The C.diff doesn't cause them any problems because its numbers are kept in check by the other gut bacteria. However treatment with broad spectrum antibiotics can disrupt this happy community, killing off vast swathes of bacteria but crucially not the C.diff which is particularly hardy. Given free rein the C.diff multiplies rapidly and produce toxins which damage the gut. In some people this causes mild diarrhoea and abdominal pain, in others it can lead to torrential diarrhoea, perforation of the colon and death.
Traditional treatment involves stopping the broad spectrum antibiotics and prescribing antibiotics which specifically target the C.diff. However C. diff is becoming resistant to these antibiotics and about 22% of patients who are treated then relapse. This can result in a cycle of illness and hospital admission which is costly to the patient and the hospital.

So it's time to start thinking outside of the box. Cue the poo transplant. The thinking goes like this- if the cause of the problem is disruption to the normal community of gut bacteria, why not just pop those bacteria back in to crowd out the C.diff? Simples. Practically, the first step is to identify a donor, usually a close relative of the patient, and screen them for a range of infectious diseases and parasites. You should also make sure they haven't recently consumed anything the intended recipient is allergic to, before asking them to make their "donation". You then pop it in a household blender, adding salt water or milk to achieve a slurry consistency and blitz it down. Next you need to strain your concoction to remove large materials- one medic in the UK uses coffee filters. Top tip. Then you're ready to administer it- about 25ml from above (via a tube into the stomach), or 250ml from below.
Now, its important to note that poo transplants are experimental. To date only small case studies have been carried out, but with 200 total reported cases, an average cure rate of 96% and no serious adverse events reported to date, it's worth carrying out a large trial to assess it thoroughly.
So, poo transplants-the ideal treatment for a cash strapped NHS. Its cheap, plentiful and it seems to work. We just have to convince people to consume someone else's poo....or, let us pop it in their bums. Bottoms up!

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