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Intestinal flora refreshed Stool transplants help against severe diarrhea
At the University Hospital Cologne infectiologists of the Clinic I for Internal Medicine have now succeeded in the first successful intestinal flora transfer with the help of capsules. Two patients who suffered from severe diarrhea as a result of Clostridium difficile infection were treated successfully at the University Hospital Cologne "with the help of encapsulated bacteria of a healthy intestinal flora", according to the Uniklinik. The procedure opens completely new options in the treatment of such infections. So far, a colonoscopy was always required for the stool transplantation, which can now be dispensed with thanks to the capsules.
Stool capsules refresh the intestine and so relieve severe intestinal complaints. Stool transplantation without colonoscopy
For over a year, the University of Cologne offers according to their own information already chair transplants. "In order to transfer the intact intestinal flora, however, a colonoscopy was always necessary so far", so the announcement of the hospital. For this purpose, a probe had to be placed in the upper small intestine on the day before the transplantation, and on the following day the flora of a suitable donor was processed and administered as quickly as possible. "The precise timing of these processes is not always easy, especially since the timing of the Darmfloraspende of course, can be difficult to influence," said the Privatdozentin Dr. med. Maria Vehreschild. In addition, some patients are "in such poor condition that placing the probe under anesthesia poses a certain risk to their treatment."
Donors for stool transplants are being extensively studied
Thanks to the new administration in capsule form, the conventional problems with the stool transplantation, according to the University of Cologne, now bypass. With the help of freezable capsules, the treatment can be carried out much easier and safer planned, reports the university hospital. For the preparation of the capsules, however, first a suitable Darmfloraspender must be found, with both related donors and strangers come into question. Beforehand, the donors are tested for a wide range of infections - similar to a blood donation, reports Dr. med. Maria Vehreschild. "So we prevent a possible infection in the context of transplantation," said the expert further.
Outpatient stool transplants possible?
As part of the processing, the donated intestinal flora is diluted with saline and then the bacteria of the flora are isolated by a multi-stage filtration process. This is followed by various centrifugation steps before the bacteria are filled into capsules, according to the Uniklinik. The capsules can also be frozen in case of doubt, with the addition of glycerol to prevent the death of bacteria during the freezing process and to allow rapid thawing within minutes before ingestion. So the capsules can be stored for several months. Finally, with the help of capsules even outpatient treatments are conceivable, explains Dr. med. Maria Vehreschild. "The ability of intestinal flora transmission based on frozen capsules offers us and our patients a whole new temporal flexibility and security in the planning and implementation of intestinal flora transmissions," the conclusion of the physician.
An American research group had already described the method of stool transplantation based on capsules last year, but patients in Germany have so far not been able to benefit from this treatment option as it was not offered by German clinics, reports the University of Cologne.
Obesity after fecal transplantation
A patient in the USA, who repeatedly suffered from diarrhea, finally receives a fecal transplant after numerous other therapeutic attempts. For a long time, such chair transplants have been used in cases of severe diarrhea. The therapy is also successful for the 32-year-old. But enigmatic way it comes after a strong weight gain.
Complaints after antibiotic therapy
The patient, a 32-year-old American, then turns to her doctor with a bacterial vaginal infection. This gives her an antibiotic, with which the symptoms disappear quickly. However, the woman gets diarrhea and abdominal pain after some time. When the symptoms persist three weeks later, the physician suspects that antibiotic therapy may have made the woman's intestine susceptible to a particular bacterium, Clostridium difficile (C. difficile). The bacillus bacterium is usually harmless to healthy people, but can be particularly dangerous to the weakened and elderly. In Europe alone, there are over 39,000 undetected Clostridium difficile infections each year. If antibiotic treatment displaces bacteria from the normal intestinal flora, it can lead to severe diarrhea in patients.
Patient receives different medications for months
The patient is only slightly overweight with her 68 kg and a body mass index of 26 and the physical examination is unremarkable. For ten days she takes an antibiotic against the infection, after that she is even worse and the symptoms return. The doctor then detects C. difficile in her stool and also finds the stomach bacterium Helicobacter pylori. He prescribes a 14-day therapy with other antibiotics, but a few weeks later, the symptoms increase again and again C. difficile can be detected. This is followed by a 12-week antibiotic therapy, but this can not prevent the pathogens come back, as well as the change of the drug.
Chair transplant successfully performed
Finally, the doctors at the Miriam Hospital in Providence, Rhode Island, offer her a so-called fecal transplant, as reported in the Open Forum Infectious Diseases. However, the woman returns to the doctor 16 months later. This time because of heavy obesity (obesity). Despite various dietary attempts, exercise programs and medically supervised, liquid protein nutrition, she has gained 17 kilograms. With a weight of 85 kilograms and a BMI of 33, she is now obese. The physicians can rule out a hormonal disorder of cortisol production or thyroid gland. The patient is now suffering from bloating, nausea and constipation. It has been reported that Neha Alang's internists, who treated the patient, believe that stool transplantation may have so confused the woman's digestive system and intestinal flora that it inevitably increases. The daughter was at the time of transplantation with 63 kilos and a BMI of 26.4 only slightly overweight, but increased in the aftermath of 13 kilos, which she was then clearly obese.
In the future only stool donations of normal weight
According to the authors, it has already been observed in animal experiments that stool transplants can contribute to obesity. The doctors discuss in the journal, whether possibly the successful therapy against Clostridia have greatly stimulated the woman's appetite or whether the Helicobacter pylori treatment could be blamed. They write: "It is well known that there is a link between Helicobacter pylori therapy and weight gain." These are attributed to the increasing levels of ghrelin, an appetite-stimulating hormone. But also genetic factors and age come as a trigger in question. The physicians aim for the future to use in chair transplants only material from normal weight donors. For their enigmatic patient, however, they could neither capture the trigger nor help her: The woman has 20 months later increased another 3.5 kilograms. (Sb)