Stool therapy may become a preferred treatment of recurrent Clostridium difficile?

Abstract

Fecal enemas were first reported to successfully treat life threatening enterocolitis in 1958, but fecal therapy to treat Clostridium difficile (C. difficile) infection has remained esoteric and not well investigated until recently. In the past few years, systematic reviews of case series and case reports of fecal microbiota transplant for recurrent C. difficile infection have become available and validate use of fecal transplant for C. difficile enterocolitis. Methods of fecal transplant reported in the literature include: nasogastric tube, gastroscope, duodenal tube, colonoscopy, rectal tube, and fecal enemas administered at home; no method has been shown to be superior. A recent randomized study published in New England Journal of Medicine found fecal transplant to be superior to oral vancomycin alone in treatment of recurrent C. difficile enterocolitis. The significance of this trial cannot be underestimated as it lends credibility to the idea of intentionally using microbes to combat disease, providing an alternative to the older paradigm of disease eradication through use of antimicrobials.

Keywords: Clostridium difficile; Enterocolitis; Pseudomembranous; Fecal transplantation; Vancomycin

Core tip: Recurrent Clostridium difficile has been a challenge for patients, clinicians and hospital alike. Drug therapy for this epidemic is still not very effective. A more traditional method of fecal transplant has been discussed in this article, but it has been an uphill task to execute. We are discussing this first randomized control study, showing overarching benefits of stool transplant over traditional drug treatment. More studies needed with similar results, before making a strong recommendation in favor of it.