Stool-based enemas can reduce recurrent diarrhea from C difficile bacteria

Recently, IBS Life reported on a capsule-based type of delivery method for fecal implants, in which capsules are pre-filled and taken as pills. We received feedback from people who freaked out about the idea of swallowing these pills to ease their painful and frequent symptoms. Even with the knowledge that the fecal content is “cleansed” before being inserted into capsules, some readers still gave us the “Eww” factor.

Another study on fecal microbiota was presented at the recent annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America. The vehicle that they’re testing this time is through the use of an enema.

According to this study presented by investigator Lindy Bancke, PharmD, the stool-based enema composed of a variety of microbes, was up to 84% effective in reducing recurrent infections caused by the bacteria Clostridioides difficile (C difficile).

Clostridioides (formerly Clostridium difficile) is a spore-forming bacterium that colonizes in the intestinal tract of patients whose normal gut microbiota is disrupted by antibiotic therapy. C difficile produces two major toxins — toxins A and B, both of which cause intestinal mucosal injury, diarrhea, and colitis. Recurrent C difficile infections (rCDI) are the most common cause of diarrhea in hospitalized patients and may lead to substantial morbidity and mortality rates.

A total of 723 patients with the rCDI condition participated. According to the study, 50-73% of those who took the enema with one dose responded well. For those who didn’t respond to the first dose, 50-79% achieved success after receiving a second dose.

The study defined treatment success as the absence of rCDI diarrhea for eight weeks after treatment of the stool-based enema. The majority of responders (82%-92%) remained free of CDI six months after treatment. The director of Massachusetts General Hospital’s FMT core laboratory in Boston indicated that this vehicle may be an alternative to pill-based stool treatment.