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Author: Dr Charlie Burgess

Poo. We all do it, it’s a natural bodily function and while most of us find the idea of doing anything other than flushing utterly revolting, the humble poo may be the answer that many sufferers of bowel problems are looking for.

The human gut is home to over 1000 bacterial species, known as the intestinal microbiota. This microbiota plays a vital role in maintaining gut, and hence our overall, health. When the balance of these bacteria is upset, through infection or antibiotic use, problems begin to arise, often leading to antibiotic associated diarrhoea (AAD), the main culprit for which is infection with Clostridium difficile. An imbalance in the intestinal microbiota provides C. difficile with an opportunity to take over, leading to the debilitating symptoms of the infection. In most cases, a further dose of antibiotics will knock out the infection and after a short while the natural microbiota will re-establish itself. But for some the constant use of antibiotics permanently upsets their gut bacteria and the C. difficile becomes a chronic infection, leading to such severe disease that quality of life is vastly reduced and even death can result.

It’s a catch 22 situation, how can the C difficile be controlled and the natural microbiota restored when antibiotics are only making the situation worse? That is where poo may help. Faecal microbiota transplant (FMT) has been used as a successful treatment for sufferers of chronic C. difficile infection for whom antibiotics are no longer a viable option. It essentially does what it says on the tin, a sample of faeces is taken from a healthy donor and a homogenous solution is introduced into the patient (generally by colonoscopy). The healthy microbiota from the donor sample restores the microbiota of the patient, preventing the C. difficile from being able to take over. It is not just chronic C difficile infections that can be treated in this manner; faecal transplant has also been reported as a successful therapy for other diseases associated with an imbalance in the gut microbiota, such as Chrohn’s disease or ulcerative colitis.

Why is this treatment not more widely used? One problem is the safety aspect, introducing faecal material from one person to another runs the risk of further infection from a variety of pathogens. However, this problem is overcome with stringent screening by clinics that offer a faecal transplant service. Another, unavoidable, issue is the ‘ick factor’. Not surprisingly, many are reluctant to receive another person’s faecal matter, and the process does not exactly smell great, making the perception in clinics rather unpleasant. There is no denying the benefits that faecal transplant can have for sufferers of chronic intestinal problems, so researchers are now looking at methods of ‘bacteriotherapy’ that help restore the natural intestinal microbiota, but remove the ‘ick factor’. Research of this kind could vastly improve the quality of life for many people who have resigned themselves to constant suffering. So next time you complain about the smell in the toilets at work, just remember the good that poo can do.

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