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Since so many members seem to be interested in this, here's the routine followed by the Mayo Clinic, when administering fecal transplants. Note that this procedure is for treating patients who have refractory or recurring C. diff infections. If they have a routine for using a similar procedure to treat IBD patients who are refractory to conventional treatment, I am not aware of it.
The transplant process goes basically like this, Khanna said:
The donor is screened.
The recipient stops all antibiotic treatments 24-48 hours before the procedure.
The recipient gets a colonoscopy to get rid of all fecal material in the body.
The donor supplies a fresh stool the morning of the procedure.
A portion of the stool, less than 2 ounces, is processed in the laboratory and inserted in the bottom part of the patient's large intestine.
"Most patients feel better in one to three days," the doctor said.
The success rate of the procedure at Mayo is 85 percent to 90 percent, and, according to Khanna, those figures are consistent across the United States.
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
This is pretty fascinating. Public TV had a special on this week all about the digestive process, and the mentioned fecal transplants as well. But the version they detailed mixed fecal matter with saline and administered the liquid through the nose.
But the version they detailed mixed fecal matter with saline and administered the liquid through the nose.
Ewww! I think I'd pass on that procedure!
Gloria
Talk about an ick factor.
Besides, running it through the stomach runs the risk of stomach acid wiping out a high percentage of the beneficial bacteria. The only bacteria that do a good job of surviving stomach acud are typically species such as H. pylori, E. coli, salmonella, shigella, campylobacter, listeria, bacillus species, V. cholerae, etc. IOW, pathogenic bacteria known to cause infections are the ones most likely to successfully survive a trip through the stomach.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Tex, I was wondering about stomach acid killing the good bacteria. Is it possible to go directly to the small intestine when going through the nose and bypass the stomach?
Also, if stomach acid destroys so much, are probiotics manufactured in such a way that they don't dissolve till they reach the small intestine?
It's certainly possible to do that with an endoscope (this is how they take biopsy samples from the small intestine for assessing damage to the villi in at least the duodenum. I'm sure it's trickier to do with a nasogastric tube, but yes, there are duodenal length tubes, so this may well be the way they do the procedure, and it should work OK, provided that the tube is inserted far enough into the duodenum to reach past the sphincter of Oddi (where bile from the gallbladder and bicarbonate from the pancreas are metered into the duodenum), because the bicarbonate will raise the pH of the chyme to reasonably close to neutral past that point (provided that everything is working correctly).
The main problem that I would have with that procedure is that NG tubes really suck, IMO. I have had abdominal surgery twice in the last 7 years (for other issues, not because of MC), and the first time the NG tube was a significant irritation, but tolerable. The second time the nurse apparently tried to run the tube into my lungs on the first couple of attempts, and she wouldn't pay any attention to my protests until she finally got tired of scraping around in my bronchial tubes and everywhere else, and decided to completely withdraw it and start over. When she finally withdrew the tube completely, naturally it was bloody, so that's when she gave up and another nurse who knew what she was doing inserted the tube.
But the damage was done. They ripped me open from above my navel to as far south as they could safely go, and I kid you not, during the first couple of weeks of recovery, the damage done by that misguided NG tube hurt a heck of a lot worse than the incision, and it was probably part of the reason why I had trouble getting off the respirator. So I'm not a huge fan of NG tubes, that's for sure.
Most probiotics are encapsulated in one way or another, and virtually all sales ads claim that survival rates are excellent, but while most of the company literature shows excellent survival rates, most of the truly independent test results I've seen show rather poor survival rates (compared with ad claims). That's why probiotics that have ultra-high bacteria counts are usually more effective.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Well, surely they usually do better. I've probably just been unlucky.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I also watched that PBS special entitled "Guts with Michael Mosley" I believe the brown liquid went directly into the intestines. I set it up to record but watched it live while working in the kitchen. I could check the tape to be sure.
Charlotte
The food you eat can be either the safest and most powerful form of medicine, or the slowest form of poison. Ann Wigmore
The recipient stops all antibiotic treatments 24-48 hours before the procedure.
This is important, but it fails to address whether a patient should start antibiotics if they weren't already taking them. I personally believe that a round of antibiotics can be useful to help knock down any bad bacterial overgrowth that might be present before introducing the donor stool. I always clear all the weeds before spreading wildflower seed; seems like the same would apply here. I suppose you have to decide if it's more important to kill the bad stuff before introducing the donor stool or or to try and salvage any beneficial bacteria that might be present. I think the former, especially since fecal microbial transplantation (FMT) is usually recommended for those with compromised gut flora usually caused by long term or high dose antibiotic use.
If they have a routine for using a similar procedure to treat IBD patients who are refractory to conventional treatment, I am not aware of it.
It's basically the same but they qualify that it's only likely to help if the cause of the IBD is pathogenic in nature. If it's candida, bad bacteria, parasite, etc. the donor stool should overcome the problem. If the cause is some mast cell/autoimmune/inflammatory response unrelated to some maurauding microbes the patient is unlikely to see significant improvement. If someone's MC developed after antibiotic use, I would think FMT would be worth a try.
The recipient gets a colonoscopy to get rid of all fecal material in the body.
Plenty of other guidance avoids the colonoscopy but does include some level of bowel cleansing to remove excess fecal material. Those with persistent D may or may not benefit from this step (and may be fearful of taking laxatives with good reason) but it's highly indicated for those with C. I'm sort of surprised this is indicated as a stand-alone step because lots of doctors prefer to administer the transplant DURING a colonoscopy. Not only for the convenience but also so they can A) have more control over where the material is planted and B) start depositing the donor stool high up in the intestines and slowly work their way back to the anus effectively treating a significant area. It's believed/assumed that the bacteria will migrate on their own since even bulb syringes have produced good results but some doctors figure this method can only improve chances of success.
I'm sure it's trickier to do with a nasogastric tube, but yes, there are duodenal length tubes, so this may well be the way they do the procedure
The top-down approach I see most mentioned includes the use of a nasogastric tube. Hopefully those folks didn't have the same nurse as Tex. The success rates for enema/colon based therapies are so high that most don't see a huge benefit in going the nasogastric route.
Theoretically, it should be helpful if the continuing cause of the inflammation is a bacterial imbalance (infection). The problem with the idea that a fecal transplant should be universally beneficial is that we do indeed have an altered intestinal bacteria population, but it's because of our altered diet, and as a result, the altered population is not necessarily harmful — it's beneficial, because diet determines the necessary bacterial balance for optimum digestion. Therefore, forcing the balance in another direction may be counterproductive. Fecal transplants work best if the donor and the recipient are both eating the same basic diet.
One member is carrying this a step further, by experimenting with the idea that fecal transplants can somehow restore his ability to eat anything he wants, and we're all very interested in that experiment. But as much as I would like to see a successful outcome, IMO, it's probably wishful thinking because of the fact that when foods trigger the production of antibodies, it's due to a gene change (rather than being due to a bacterial imbalance), and resetting genes is beyond the scope of ordinary fecal transplants. I'm not saying that genes cannot be reset, because they definitely can (and they can even be triggered or reset by gut bacteria), but unfortunately, exploiting that technology is way beyond the current level of our understanding and working knowledge of the characteristics and functioning of symbiotic gut bacteria.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I want to hear the results of that experiment.........
Ever since you posted the poll question about root canal, I've wondered about that (of course, I've wondered about drugs I've taken as well) as my trigger. I had an infection under a tooth that had already had a root canal. I learned that root canals can fail.
DISCLAIMER: I am not a doctor and don't play one on TV.
I want to hear the results of that experiment.........
Ever since you posted the poll question about root canal, I've wondered about that (of course, I've wondered about drugs I've taken as well) as my trigger. I had an infection under a tooth that had already had a root canal. I learned that root canals can fail.
I am going to try this. Been reading how to diy from http://thepowerofpoop.com/epatients/fec ... e-big-day/.
Yes, there is a mental hurdle to overcome but living like this is hell. It's going on 9 years and I worry about colon cancer. I have a husband I've been with for 7 years now, he is healthy as a horse and is willing to be my donor. I want a cure. I will let you know how it goes. Currently, I am going to be very anal about prepping(no pun intended) before I start this. I begin hopefully within a month or so. From what I read it takes 30 days of FMT's to health from an IBD and then one a week for a while then once a month. I will let you know how it goes when it is all said and done.
Talk about an ick factor. 
