There's a great article in The Atlantic on fecal transplants for C. difficile infection (free full text
here). What I like about this piece is that it describes the very real barriers to fecal transplantation without any sugar coating. It also highlights the work of Dr. Bruce Hirsch, an infectious disease doctor who crafts capsules with fecal bacteria (or "crapsules" as he calls them) so that patients can be transplanted without an NG tube or colonoscopy.
Photo: Salon.com
That's such a great idea!! Although, what would happen if the pill gets stuck in the esophagus? I guess the bacteria would eventually fall to the stomach and die with gastric pH?
ReplyDeleteI do all my fecal transplants via NG tube with the tip of the tube in the stomach. All the patients are treated with a PPI the night before and morning of the procedure. So if I had access to those crapsules (and sure wish I did!) I'd give a PPI.
ReplyDeleteThis story also makes somewhat clear what the motivation for FDA trying to start regulating fecal transplants earlier this year. It's pretty clear that the treatment is close to turning into a product that will be sold, i.e., capsules, and they probably saw this coming. (and people will be trying it for UC, Crohn's, MS, RA, etc.) Why the IND didn't make sense was that it's still not a drug. And it still also makes no sense in comparison to the FDA doing nothing about the widespread unregulated "Wild West" sale of human breast milk, or what people purport to be breast milk, and the buyers feeding this untested, unregulated who-knows-what-it-really-is food to their infants. Any comments on this, or earlier blog posts? There was a story in the NY Times about it several weeks ago...
ReplyDeleteI can't speak for the FDA, however, I imagine they have to tread lightly (and cautiously) with this product. Too much regulation and the "underground" DIY transplants become more popular than I suspect they already are. Too little control from the FDA and every Tom Dick and Harry open up a "Crapsule Market".
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