November 13, 2013
Pediatric gastroenterologists Maria Oliva-Hemker, left, and Suchitra Hourigan with a fecal transplant patient.
Call it therapeutic poop, if you will, but the best hope yet for an effective treatment of childhood infections with the drug-resistant bacterium C. difficile may come straight from the gut, according to recent research. Parlaying that research into practice, the Johns Hopkins Children's Center has launched a fecal transplantation program for patients with recurrent diarrhea caused by what they say is a wily pathogen that is increasingly impervious to drugs and a rapidly growing problem among children and adults.
“Fecal transplantation—or the transfer of ‘good’ bacteria from the colon of one person into the colon of another—should be considered for all children with C. diff infections who don't respond to two standard courses of antibiotics,” says pediatric gastroenterologist Maria Oliva-Hemker.
Such beneficial bacteria work by keeping rogue players in check, Oliva-Hemker explains, so any shifts in gut environment—such as ones caused by antibiotics—can have dire consequences. When good bacteria are killed off by antibiotics, the bad guys multiply causing an imbalance or “dysbiosis,” Oliva-Hemker says. Typically, gut infections caused by one antibiotic are treated with another one to eradicate the overgrowth of harmful pathogens, but drugs often fail to do so fully or permanently because they only treat part of the problem.
“When we administer an antibiotic to treat the C. diff infection, we destroy some of the bad bacteria, but that does not address the other half of the problem—the loss of good bacteria that might have led to the infection to begin with, so we never truly restore the balance in the gut and often the diarrhea returns with a vengeance in a matter of weeks,” says pediatric gastroenterologist Suchitra Hourigan.
The concept of treating poop woes with poop is hardly new. The method originated with ancient Chinese healers who gave their diarrhea-ravaged patients “yellow soup,” a concoction of fecal matter and water. Nowadays, fecal transplants are often performed during a colonoscopy, and improvement can be seen in as short as two weeks, as beneficial bacteria start to repopulate the patient's gut, Hourigan says. Studies in adults show that more than 90 percent of patients are cured following such therapy and, experts say, they have every reason to believe the numbers would be equally impressive in children.
Johns Hopkins Children’s Center is one of only a handful of pediatric hospitals in the country to offer this therapy for a condition that can cause dehydration, anemia and pain, and can seriously affect a child’s quality of life, leading to absence from school.