Fecal Transplantation: 'We Have an Effective Treatment, but It's Too Gross'


Despite new evidence in support of the practice, an "ick factor" would prevent some practitioners from recommending donor feces infusions to patients. Maybe it just needs a nicer name?

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The Internet remains abuzz about a small Dutch study published in the New England Journal of Medicine last week that supports the practice of fecal transplantation -- taking a healthy person's feces and running it through the bowel of someone suffering from a C. difficile infection -- as an effective adjunct therapy.

Where to begin. No, it's not an innately appealing concept -- having someone else's poop where there's only supposed to be your own. It's not a dinner-party or first-date conversation starter. It might even speak to other behavioral issues if you were unabashedly on board with the idea when you first heard it. But for all that gastroenterologists see and deal with, this isn't really above or beyond. It's actually something we've been doing since the 1950s, in some places. Just for perspective, next time you're hanging out with a gastroenterologist, ask them what the grossest thing they've ever seen is. You'll feel a lot more comfortable with a little fecal lavage. 

What does seem above and beyond is some of the responses to this survey at MedPage this morning:

Another study has shown the benefits of fecal transplantation for patients with persistent intestinal complaints, but many patients may find the concept repugnant. Would the "ick factor" associated with fecal transplantation prevent you from recommending it to patients?

The answer is no, that C. diff is a bad infection and we would recommend treating it by the most effective methods we have. Of 1,438 responses, though, 24.5 percent said yes.

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Caveat, granted, we don't know how many people responding to this survey were actually doctors or other medical professionals; you don't have to show credentials to participate. But flawed sample aside, the percentage of physicians who wouldn't offer a therapy because it's ick should be zero. If you don't agree with it medically, that's a separate thing.

As gastroenterologist Colleen Kelly at Brown University told the New York Times, "Those of us who do fecal transplant know how effective it is ... The tricky part has been convincing everybody else ... hopefully [the New England Journal paper] will encourage people to change their practice patterns and offer this treatment more."

So, let's talk about this until it's not ick. Dr. William Martin gets the ball rolling in the survey comments: "Fecal transplants can be made more palatable by employing freeze-dried fecal material enclosed in capsules." See how much more palatable that is?

And maybe it just needs another name. Being a fecal transplant recipient doesn't sound appealing. Like if we work "cleanse" in there, it has to be good for us, right? Or something demurely Latin-ish, as nurse Kathy David suggested: "trapianto fecale, ordure przeszczep, or fecel trunsplunt."

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James Hamblin, MD, is a senior editor at The Atlantic.


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