The VERY unusual way to get rid of a nasty gut infection
A RADICAL new treatment is being used to tackle gut infections resistant to antibiotics. Retired civil servant Pat Birdsey, 65, from Southsea, Hampshire, tried it, as she tells ADRIAN MONTI.
THE PATIENT
Ten years ago, I was diagnosed with a chronic condition that made me very short of breath — idiopathic pulmonary arterial hypertension.
One drug had to be given intravenously, so a line went into my chest, with a pump around my waist, to give me a continuous supply.
unfortunately, in november 2014, I developed an infection and spent two weeks in hospital being pumped with antibiotics.
Immediately after leaving hospital, I suffered severe diarrhoea. Tests showed that I’d picked up a Clostridium difficile (C.diff) infection. Apparently, the antibiotics had made me susceptible as they affect the balance of bacteria in your gut.
I was given another course of antibiotics but it didn’t work, and for the next ten months I had ongoing diarrhoea.
It was horrendous, as I’d urgently need the loo every two hours, which made it difficult to look after my grandchildren. I lost my appetite and a stone in weight, dropping from a dress size 14 to 12.
My GP prescribed a strong antibiotic called vancomycin, which helped a bit. But whenever a fortnightly course ended, the diarrhoea returned.
Then, in March 2015, I needed a repeat prescription and saw a locum GP. He said he’d heard of a new procedure using donated faecal matter to treat C.diff.
Basically, I had too much C.diff bacteria in my gut and not enough ‘good’ bacteria. This treatment — delivered via a tube in my nose — could apparently balance it out.
I thought the GP was joking but he said it was true and gave me some information about it.
Two months later, I was referred to a clinical microbiologist called Dr Andrew Flatt. He agreed that I might benefit from the procedure because the antibiotics weren’t killing the infection. It sounded bizarre but I was desperate enough to try anything.
THE day before the procedure in August 2015, I stopped taking antibiotics and a fine plastic tube was inserted into my nose, down my food pipe and through my stomach into my small bowel. It was a bit uncomfortable but I could eat normally.
The evening before the procedure, I drank four litres of a laxative to clear my system.
An X-ray was taken to check the tube was correctly in place before I had the transplant in the radiology department. Dr Flatt fixed a second tube to the nasal one before syringing through the treatment.
I tried not to think of what was going into me during the transplant, which took just seconds. The tube was removed about 30 minutes later. Strangely, I felt better almost immediately.
The next morning I went to the loo normally for the first time that year. I couldn’t believe how quickly the transplant — which was nowhere near as bad as it sounded — had worked.
I haven’t suffered diarrhoea since. Finally I could stop worrying where the nearest loo was and get my old life back again.
THE CONSULTANT
DR ANDREW FLATT, a consultant medical microbiologist, is based at the Queen Alexandra Hospital in Portsmouth, Hampshire.
HUNDREDS of different species of bacteria live in a healthy human gut. normally, the bugs maintain a balance that keeps our digestive system functioning properly.
But our gut microbiota — the microbe population living in our intestine — can be altered by antibiotics. These change the balance of the microbiota, with some species of bacteria reduced while others multiply.
One type of bacteria that increases is C.diff, which is carried by about 5-10 per cent of the population without causing any problems. It overgrows and produces toxins that cause C.diff infections, though we don’t know why it suddenly becomes problematic in some people.
It can cause diarrhoea that lasts for years if untreated. In rare cases, the colon becomes so inflamed that surgery is required. Among the frail, the symptoms can be life-threatening. The standard treatment is anti-C.diff antibiotics such as vancomycin, but the chance of the infection coming back is about 20-25 per cent.
Another course of vancomycin may be effective, but sometimes the symptoms return when the course finishes.
research shows that patients with C. diff infections can recover if their gut bacteria is repopulated with a donor stool.
In 2015, we set up the second frozen faecal bank in the country after Birmingham’s Heartlands Hospital. We now supply our own patients with this resource that we collect and store. We have five active donors. Once a potential donor comes forward, they complete a questionnaire designed to highlight any problems with their suitability to donate (such as a family history of chronic gastrointestinal illnesses).
next, the donor provides a stool and blood sample. The former is tested for known pathogens — bacteria, viruses and parasites that cause infections such as salmonella or norovirus. The blood sample is screened for diseases such as hepatitis and HIV.
EACH donated stool sample is processed into concentrated liquid stools called aliquots that are then frozen. each sample makes 12 aliquots of about 50ml each that can be used for 12 separate transplants.
This is blended with saline and undigested food is filtered out. Glycerol (liquid sugar) is added to help the bacteria survive. It’s then stored at -80c and kept in quarantine until quality checks are carried out. The aliquots can be stored for up to 12 weeks. When needed, one is defrosted on the day.
During a transplant, I use a syringe to send the aliquot down the tube straight into the patient’s small bowel.
Our figures show that 80 per cent of these transplants are successful at first attempt. And of the 20 per cent where it fails, the patient can undergo a second using a different donor. Overall, the success rate of two treatments is 94 per cent.
Here at Portsmouth we’ve carried out 42 transplants using frozen samples since we introduced it 18 months ago. Before then, we used fresh samples, including the one for Pat.
Ongoing research is looking at whether this treatment may one day help patients with conditions such as IBS, ulcerative colitis and Crohn’s disease.
The transplant cost is being reviewed, but two years ago, Pat’s cost less than £100.