Fecal Transplant study: 58-70% response rate

Rrrr

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This is an Australian Fecal Transplant study that had a 58-70% response rate for ME/CFS!!!

For treating CFS (published oct 2012)
http://www.eventscribe.com/2012/acg/ajaxcalls/postersinfo.asp?title=6110

Bacteriotherapy in Chronic Fatigue Syndrome (CFS): A Retrospective Review

Conclusion: Bacteriotherapy achieves initial success rate of 70% in CFS and 58% sustained response. This result is favourable when compared with current therapies where fewer than 10% recover fully and a further 10%-20% worsen during follow-up1. Given that manipulation of the colonic microbiota improved CFS symptoms, bacteriotherapy for CFS warrants further investigation. Furthermore, the pathophysiology of CFS could be in part explained by enteric derived toxin-releasing bacteria capable of producing systemic effects.

Disclosures: Thomas J Borody has a pecuniary interest in the Centre for Digestive Diseases and has filed patents in this area.
 
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Rrrr

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if we can get past the "yuck!" factor for a minute...

has anyone here tried this? it can be done at home with a simple blender and enema bag. i have done some research into this, if anyone wants me to send it to them, let me know via private message. i think there is already a thread on this somewhere on Phx Rising. i'll go look. but meanwhile, this is what i found about how to do it yourself at home.

HOW TO DO IT YOURSELF

1) http://www.mediafire.com/?xyp9k29alurs1c5
(or for this same document, see my separate file on this on my computer)

2) http://www.nleducation.co.uk/resources/reviews/pass-the-poomedicine/

3) more details here, including putting it thru a coffee grinds
http://scienceblogs.com/aetiology/2007/12/17/fecal-transplants-to-cure-clos/
and same info here
http://cid.oxfordjournals.org/content/36/5/580.full
Select a stool specimen (preferably a soft specimen) with a weight of 30 g or a volume of 2 cm^3. Add 50-70 mL of sterile 0.9 N NaCl to the stool sample and homogenize with a household blender. Initially use the low setting until the sample breaks up; then, advance the speed gradually to the highest setting. Continue for 2-4 min until the sample is smooth. Filter the suspension using a paper coffee filter. Allow adequate time for slow filtration to come to an end. Refilter the suspension, again using a paper coffee filter. As before, allow adequate time for slow filtration. 25 mL of the suspension is then transferred to the recipient, who’s already been prepared for the transplant via treatment with vancomycin (to kill off as much existing C. difficile as possible) and omeprazole (Prilosec, to decrease stomach acid production). The tube is then flushed with a salt solution and removed, and the recipient is free to go. (They were followed up either via phone or return visits to the clinic).

4) http://scienceblogs.com/aetiology/2007/12/17/fecal-transplants-to-cure-clos/
Someone wrote in the comments section of this article
If you’re thinking of doing a fecal transplant for crohn’s, c. diff or whatever, it’s better to use a sterile saline solution to mix up the poop than water. Water destroys some of the good bacteria. One doesn’t need to get this done by others – you can do it in your own home. Just get some donor poo (I recommend a complete screening of the donor person for diseases)and mix it in a blender with saline solution until it is very watery and smooth. Strain it through a fine strainer into a container and then suck it up into a rectal syringe. Squeeze it in to your bum like a fleet enema. Leave it in for about an hour and a half. If you have trouble leaving it in, lie on your back and put two pillows under your bum, elevating it. This helps keep it in. Do this every second day for a few weeks and you’ll be better!

Another commenter:
Just purchase a three pack of enema containers (4.5 oz size is fine) from the drugstore. Mix a small amount of stool about half the length of your thumb in a blender with about 8 oz of .9 saline solution. He may need his doctor to call in a prescription for the .9 saline solution. It’s often used for irrigating wounds and such, so the pharmacy will have it but a prescription is needed. Dump out the water that’s already in the enema container as it contains a laxative. Mix the stool in a blender with the .9 saline solution and poor into the enema container. Insert the contents of the container in the rectum and hold at least a couple of hours, if possible. Then repeat the procedure every other day for 3 enemas. He will feel better very soon, likely within a week. Donor should be tested for c-diff and other parasites first. It is amazing how effective this procedure is!

Another commenter:
Self-administered a transplant using my husband as a donor almost a month ago with amazing results! The key really was finding an enema bag with an occlusion bulb so I could hold in the transplant for 2 hours.

5) buy a guidebook on how to do this
http://fecalinfusions.com/
_____

PRE-TRANSPLANT PROCEDURE FOR RECIPIENT

http://www.nleducation.co.uk/resources/reviews/pass-the-poomedicine/
Transplantation Protocol

Recipients were initiated on maintenance therapy with oral Saccharomyces Boulardii (Florastor; Biocodex Inc,) 500 mg orally twice per day, plus metronidazole 500 mg orally 3 times per day or vancomycin 125 mg orally 4 times per day, to ensure they were asymptomatic until 24–48 hours prior to the procedure. All patients were asked to return to clinic for follow-up 2 weeks post procedure.[25]
 

Esther12

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Looks like it was mainly for people with IBS-CFS:

"A total of 60 patients presented with CFS (52 IBS-CFS, 4 Constipation-CFS, 4 CFS)"

That actually makes the results seem more plausible.

Lack of a control group is a big problem.

A quick google made Borody look credible (I could be wrong though).

Who knows? Would be good to see results from a blinded RCT.
 

Dolphin

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It looks like it's a 1995 conference abstract:
"Presented at the CFS National Consensus Conference, 1995. Sydney."
No, that's just one (of two) references.

This is the reference as far as I can see:
Citation: . BACTERIOTHERAPY IN CHRONIC FATIGUE SYNDROME (CFS): A RETROSPECTIVE REVIEW. Program No. P362. ACG 2012 Annual Scientific Meeting Abstracts. Las Vegas, NV: American College of Gastroenterology.
 

Art Vandelay

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I saw Tom Borody about 5 years ago when he treated me for an antibiotic-resistant blastocystis hominis infection which was causing severe gastrointestinal symptoms. He's an incredibly intelligent, motivated and compassionate man.

Thankfully I only needed a few courses of (very strong) antibiotics to kill the infection, rather than having to resort to a fecal transplant. Successfully treating the infection managed to greatly reduce my IBS symptoms, but it did not alleviate any other CFS symptoms.

I have heard of CFS patients who have improved after having a fecal transplant, however the few that I spoke to slipped backwards again a few months later so I decided not to undergo this treatment myself.
 
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I saw Tom Borody about 5 years ago when he treated me for an antibiotic-resistant blastocystis hominis infection which was causing severe gastrointestinal symptoms. He's an incredibly intelligent, motivated and compassionate man.

I have heard of CFS patients who have improved after having a fecal transplant, however the few that I spoke to slipped backwards again a few months later so I decided not to undergo this treatment myself.
Damn. It sounds feasible when you consider how many cfs problems are linked to the gut.
Thanks Vandelay, for feedback.

As for home fecal transplants, i have no problem with the ick factor.
Its trying to convince people that me/cfs is not a mental illness then asking them for their stool that is the difficulty. (Or difficile).
Its hard to believe that something that is generally considered beneath worthless should be so hard to aquire!

At least we cant suspect big pharma conspiracy in this therapy.
 

taniaaust1

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As for home fecal transplants, i have no problem with the ick factor.
Its trying to convince people that me/cfs is not a mental illness then asking them for their stool that is the difficulty. (Or difficile).
LMAO.. yeah I'd think that would be difficult to get them to give that one up. It makes me get this little cartoon comedy playing out in my head of someone saying "I only want your poo.. please, please give me your poo" while trying to convince the other that the illness isnt a mental one.

(I'd personally be worried about parasites seeing 25% or more people carry them)
 

alex3619

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We really need long term follow-up. It should be possible. If it can be shown that many of those who responded remained well long term, with appropriate data, this would be a breakthrough. However its too early for this, being only recently published. If the same subjects are followed up a year from now, that would be interesting.

I suspect the cultures used are a carefully selected blend. While I haven't read the methods section of the paper yet, I don't even have the paper, my guess is this is not so easily replicated at home. If each bacteria is grown in isolated media, tested for contamination, and then recombined according to a formula, many issues raised including possible parasites would be all but eliminated. If this is not the case then I can see problems from this down the road, though such problems are probably technical and can be dealt with.

I suspect gut bacteria issues are part of a complex puzzle. Correcting part of the problem will help, but its not enough ... but thats only a supicion, I hope I am wrong. Bacterial ecology of the gut interacts with the immune system. What happens when you combine this with specialized diets, immunomodulation and selected nutritional supplements? There is very much an absence in the research of those trying combination treatments.

On a more humorous note, does this mean we might be putting out a call for poo donors? Will there be a poo bank?
 
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We really need long term follow-up. It should be possible. If it can be shown that many of those who responded remained well long term, with appropriate data, this would be a breakthrough. However its too early for this, being only recently published. If the same subjects are followed up a year from now, that would be interesting.
.
Hi alex,
http://www.eventscribe.com/2012/acg/ajaxcalls/postersinfo.asp?title=6110. It seems to be suggesting that it was followed up.

' At 15-20yr follow-up 12/60 patients were contactable and 7/12 (58%) remains CFS-free. 5/12 experienced CFS recurrence approx 1.5-3 years post bacteriotherapy.'

They must have been experimenting with fecal transplant for cfs in the early nineties. ?? Surprising.
 

taniaaust1

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Hi alex,
http://www.eventscribe.com/2012/acg/ajaxcalls/postersinfo.asp?title=6110. It seems to be suggesting that it was followed up.

' At 15-20yr follow-up 12/60 patients were contactable and 7/12 (58%) remains CFS-free. 5/12 experienced CFS recurrence approx 1.5-3 years post bacteriotherapy.'

They must have been experimenting with fecal transplant for cfs in the early nineties. ?? Surprising.
Wow..thats awesome compared to other treatment success rates around the place.
 

Bob

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http://www.eventscribe.com/2012/acg/ajaxcalls/postersinfo.asp?title=6110. It seems to be suggesting that it was followed up.

' At 15-20yr follow-up 12/60 patients were contactable and 7/12 (58%) remains CFS-free. 5/12 experienced CFS recurrence approx 1.5-3 years post bacteriotherapy.'
Some of these patients might have improved over time anyway, so without a control group, it's not possible to say that 58% were CFS-free as a result of fecal transplant.

But it's still very interesting.
 
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Some of these patients might have improved over time anyway, so without a control group, it's not possible to say that 58% were CFS-free as a result of fecal transplant.
.
Thats true. We need more results dont we. But a short term response is not to be sneezed at.
We cfsers think nothing of routine maintenance of supplements and medication. Fecal transplant might come within that range very shortly. In pill form!
 

alex3619

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I have heard of these types of experiments for many years, though at the time I think they were at the pain unit at Newcastle University NSW. This follow-up is very sketchy. There needs to be a larger and more extensive study, with programmed follow up. My GP would know about this kind of thing, it was he who mentioned these studies to me several times iirc. I get the impression this is not even a pilot study, its a collection of case studies over 20 years.

However one of the things I am interested in is that lipopolysaccharide, a class of bacterial toxin, may trigger pathological changes in us. This is because in healthy people its confined to the gut and the portal blood supply from the gut to the liver. In us its systemic. One of the things this induces, at least in localized bacterial infections, is migration of immune cells, including gamma delta T cells. I am trying to understand what systemic LPS infection in the body will do. So far its more confusing me that helping me. What would happen though if you reduced the LPS levels by reducing LPS producing bacteria in the gut?

Its worth noting that gamma delta T cells can both switch on and switch off the immune response depending on conditions. I wonder, pure speculation at this point, if it could be that the migration of gamma delta T cells away from the gut wall increases immune response in the gut, leading to more gut damage, resulting in more LPS translocation to the blood stream, which overwhelms liver detox and gets into the blood, resulting in more gamma delta T cells migration, which leads to more gut damage. This would be another vicious cycle mechanism, the first of which I encountered in 1993 and which involved changes in diet that I now can show would increase gamma delta T cells presence in the gut wall.

One of the things that gamma delta T cells do to the gut is increase healing, partly by suppressing the immune response. My idea is that improving gamma delta T cell numbers in the gut might break the vicious cycle. Altering gut ecology could help.

What would this look like? Possibly too many gamma delta T cells in the blood. While at least one lab has suspected this, other immune studies have not found it.

Bye, Alex
 

natasa778

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I posted this a while ago in its own thread but guess wasn't noticed ...

Allen Vercoe's presentation is well worth watching as discusses this 'treatment' in great detail and especially for the potential of their RePOOPulate 'product' being devoped in near future :) :)

Poopobot machine sputtering next-gen live probiotics mixes cultured from different 'donations' ... who would have thought this would be the future of medicine!