A 78-year-old Delhi resident suffering from recurrent inflammation of the large intestine and bloody diarrhoea has recovered after doctors from Sir Ganga Ram hospital treated him with faecal microbiota transplant (FMT), a procedure where stool from a healthy person is put into the colon of the patient.
Despite treatment with antibiotics, the symptoms kept reoccurring in the patient and he was admitted to the hospital with fever, bloody diarrhoea, low blood pressure, and high heat rate. When his stool was analysed, the doctors found a bad bacteria called c. difficile.
A c. difficile infection disrupts the growth of normal, healthy gut bacteria and is often a result of prolonged antibiotic use. It can cause severe symptoms that can be fatal.
“FMT is the up and coming treatment. However, the knowledge and acceptability of the treatment is not very high. It is the first line of treatment in patients with recurrent pseudomembranous colitis (inflammation and ulceration of the large intestine), but I don’t think it has been used in the country yet,” said Dr Piyush Ranjan, vice-chairperson, Institute of Liver Gastroenterology and Pancreatico Biliary Sciences, Sir Ganga Ram Hospital.
Although anyone with a healthy gut microbiome can be a donor, he said, the Centre encourages it to be a family member to increase acceptability. “No one wants the stool of an unknown person in their gut, so we encourage family members. In the United States, however, people who have a healthy gut can become donors and it can be used for the treatment of several patients,” said Dr Ranjan.
For the treatment, the faecal matter is blended with saline, distilled, and inserted in the large intestine with colonoscopy. It can also be given in the small intestine through a nasal tube.
“We have done FMT for people with alcoholic hepatitis (inflammation of the liver due to alcohol consumption); we have published a four patient case series. CMC Ludhiana has published a 14 person case series for other indications, and Institute of Liver and Biliary Sciences has also published a seven patient case series,” said Dr Ranjan.
Human intestine harbours billions of bacteria that are collectively referred to as gut microbiome. These bacteria play an active role in maintaining human health, and there are a number of diseases which arise from imbalance of gut bacteria. A state of disbalance between the good bacteria and harmful bacteria is referred to as dysbiosis.
One of the important ways by which these bacteria influence health and disease is by modulating the immune response of the body. They affect both innate immunity that is the reaction of body to a foreign antigen when the body is exposed to it for the first time, and also the adaptive immunity.
The treatment is offered in the outpatient clinic and costs R 25,000 per session. “For PMC, only one session is needed, but may be repeated if needed and the patient is responding. For alcoholic hepatitis we do around three sessions,” he said.
The patient has been healthy for two months now after receiving the transplant in November.