July 1, 2013

COLUMBUS, Ohio – After suffering for more than a year with severe diarrhea and fatiguedue to an intestinal infection caused by the “superbug” Clostridium difficile, or C. diff as it is more commonly known, Kim Brinkman of Ashland, Ohio, was ready to try anything to help her feel better. And now she is better.

Brinkman was helped by Razvan Arsenescu, MD, PhD, medical director of the Inflammatory Bowel Disease (IBD) Clinic at The Ohio State University Wexner Medical Center. He recently performed what is known as a “fecal transplant.” Brinkman is the second patient Dr. Arsenescu has treated at Ohio State, using a donor’s stool sample to relieve the serious, recurrent diarrhea and other symptoms caused by C. diff.

In a procedure similar to a colonoscopy, a golf-ball sized stool sample from a healthy donor is diluted with saline and flushed through the scope, covering the lining of the sick patient’s colon with the stool. C. diff infections most often occur after antibiotic use; as healthy good bacteria in the gut are wiped out and the toxic C. diff germs take over. Fecal transplant recipients usually report feeling better within days, as the donor’s good bacteria recolonizes their bowel with good bacteria, Dr. Arsenescu said.

“Recent studies have shown that fecal transplant for recurrent, severe, C. diff infections is a safe and effective treatment – with up to a 95 percent cure rate. This relatively uncommon procedure is rapidly becoming a treatment of choice for these patients,” said Dr. Arsenescu, a gastroenterologist who is an international expert in the treatment of Crohn’s disease and ulcerative colitis. “We’re finding that many diseases can be affected by the bacteria that live in our bowel, and the ‘good’ bacteria from a donor can be harnessed to help heal the body.”

Dr. Arsenescu works closely with infectious diseases experts at Ohio State’s Wexner Medical Center, including Dr. Julie Mangino and Dr. Nicole Theodoropoulos, to appropriately screen the donors to assure that the stool samples do not have any potentially transmissible infections. Donors are often a friend or a family member, who are entirely healthy and do not have any potentially transmissible infections or diseases. Ideal donors are lean, nonsmoking, vegetarians who haven’t been hospitalized recently or been on any antibiotics in the past six months, Theodoropoulos said.

“The fecal transplant is a last resort to improve quality of life, in those patients who have failed appropriate courses of therapy many times, but continue to develop recurrent C. diff infections,” Theodoropoulos said.

According to the Centers for Disease Control and Treatment, recurrent C. diff infections affect more than 337,000 people each year, and are linked to 14,000 deaths. The FDA announced that practitioners were required to obtain an investigational new drug application to perform this procedure. More recently this decision was reversed and a well-documented consent form suffices, Arsenescu said.

Although new to central Ohio, the fecal transplant procedure has been in the medical literature at least as far back as 1958, and was first documented in the early 1990s by researchers in Norway investigating the best way to treat C. diff infection.

C. diff illnesses range from mild diarrhea with abdominal cramping to an inflammation of the colon and rarely a bloodstream infection to death. Most patients with C. diff are treated with antibiotics such as metronidazole, sold as Flagyl, or vancomycin, but for patients such as Brinkman, those drugs do not always work. Brinkman began feeling better within days of her fecal transplant, however...

For now, to be eligible for a fecal transplant, patients must have failed at least two courses of antibiotics. In the future, Arsenescu hopes that will change. “This would be my first choice for a first-line treatment for carefully selected patients with C. diff, rather than a last resort,” Arsenescu said. “I hope that we can someday expand the use of fecal transplants to help patients with other autoimmune diseases, including diabetes, lupus, Crohn’s disease and ulcerative colitis, along with obesity. More research is needed, but the applications could be vast.”

The Ohio State University Wexner Medical Center’s division of Gastroenterology, Hepatology & Nutrition provides clinical service to patients in Columbus and the Midwest region.

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Contact: Eileen Scahill, Wexner Medical Center Media Relations, 614-293-3737 or Eileen.Scahill@osumc.edu

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