That gut feeling: Poop transplant to the rescue

As bizarre as it may sound, poop transplantation can treat painful inflammatory bowel conditions that usually don't respond to antibiotics and steroids.

Raahil Batin, 7, developed a chronic and debilitating inflammatory gut condition within months of his family moving from New York to Mumbai in 2010. He was less than two years old.



Over the next two years, Raahil's symptoms worsened. He developed symptoms of diarrhoea that was sometimes bloody, abdominal pain and weight loss.



"We don't know what triggered it. We have no family history of gastrointestinal disorders so its cause is very likely to be environmental. I suspect he picked up an infection that wrecked his digestive system," says his mother Afreen Mehdi, 40.



Though the family lived in Mumbai's upscale Pedder Road, where Raahil even joined a playschool, his symptoms still worsened. Finally, his paediatritian recommended a colonoscopy that showed inflammation in the colon. He was diagnosed with ulcerative colitis. Raahil was just three-and-a-half years old.

According-to-the-survey-the-incidence-of-chronic-constipation-was-significantly-higher-in-Mumbai-with-19-of-people-suffering-from-the-problem-Shutterstock

Ulcerative colitis is a chronic relapsing inflammation of the intestine, with genetics, stress, drugs and bacteria flora playing a variable part in disease etiology," says Dr Anupam Sibal, group medical director, Apollo Hospitals Group.



Stubborn bug

Antibiotics and steroids were prescribed to treat Raahil's flare-ups but the symptoms returned within days. "Also, antibiotics kill good gut bacteria and steroids cause severe side effects, so we did not want to overuse them," says Mehdi, who moved to Singapore in 2012 to give her son a more sterile environment.



"The first line of treatment is antibiotics, but infection returns within days or a couple of weeks of the antibiotic course getting over in 30% people affected with ulcerative colitis. In such cases, the restoration of bacterial flora in the gut using Faecal Microbiota Transplantation (FMT) can offer relief from pain, other symptoms," says Dr Sibal, who performed Raahil's FMT at New Delhi's Indraprastha Apollo Hospitals last year.



Sabina Mehra* underwent FMT thrice. She now says her painful bowel symptoms are almost gone. "I've had very painful C. difficile colitis since I was 19, and though I first heard of FMT in California in 2011, it sounded so disgusting that I took more than a year to decide to opt for it," says Mehra.



After three treatments in Chicago, she was so pleased with the results that she is now confident enough to get a DIY kit and try it at home. "You can buy sterile kits at pharmacies and since it works like an enema, you can also do it at home," says the 28-year-old Mehra, who works as a marketing executive for a pharma multinational.



Treating resistance

FMT involves the delivery of stool from a healthy pre-screened donor to a person with gastrointestinal conditions associated with changes in the gut flora, such as recurrent C. difficile colitis and ulcerative colitis. Donors are vigorously screened and people with a history of irritable bowel syndrome, abdominal pain, gastrointestinal malignancy, prolonged diarrhoea, and antibiotic use within one month before FMT are rejected.



Healthy bacteria are infused in the colon using a colonoscope, in the distal lower gastrointestinal tract using an enema or rectal catheter, and the upper gut through a nasoduodenal tube or a gastroscope. "I prefer the term 'faecal transfer' or 'faecal transfusion' as it does not require surgical implantation even though the same stringent donor selection, screening and follow-ups are required for improvement and possible side effects, if any," says Dr Sibal.



And there are studies to back this. Faecal transplantation is a useful tool in the fight against ulcerative colitis, reported a study from McMaster University in Canada in the journal Inflammatory Bowel Diseases earlier this month. "Our animal research provides insight that selected bacterial groups, involved in gut health, are important for protecting the colon against injury and inflammation," said lead researcher Elena Verdu, associate professor of medicine at the university, in the study.



In 2013, New England Journal of Medicine reported FMT cured 94% of patients, while antibiotics (oral vancomycin) cured 27%. The disparity was so huge that the researchers stopped the trial early, on the grounds that it was unethical to deny the better cure to the group assigned antibiotics.



Another review article in the journal GIE: Gastrointestinal Endoscopy showed FMT cured 92% of patients of their recurrent C. difficile, with a range of 81% to 100%. The study found patients experienced a 91% primary cure rate and an astounding 98% secondary cure rate, the latter defined as cure using antibiotics to which patients had not responded before FMT. Three in four (74%) patients who had symptoms for an average of 11 months before FMT reported symptoms going away within three days.



Repeat factor

Sibal suggested FMT to the Batins last year. "We had read about FMT being used to treat digestive disorders online so when Dr Sibal said we could do it in New Delhi, we decided to go ahead," says Mehdi.

The cure, however, is not permanent and most patients have to undergo repeat procedures when symptoms reappear.



Raahil underwent FMT late last year. His father Masroor Batin was the donor. "It really helped him, his life has undergone a major transformation," says Mehdi. "He has gained weight and does all the things boys his age do, swimming and going for taekwondo classes. He was symptom-free for more than seven months but had a relapse in the eighth month. So now we're considering a second transplant," says Mehdi.



(*Name withheld on request)

Unlock exclusive access to the story of India's general elections, only on the HT App. Download Now!