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Gross, but Appears to Work

Based on a small study, Amsterdam researchers find that fecal transplantation works better than vancomycin therapy to treat recurrent Clostridium difficile infections, which they report in The New England Journal of Medicine.

Forty-three patients were randomly assigned to receive donor feces, vancomycin, or vancomycin and bowel lavage treatment. Of the 16 patients who received donated feces, 13 were cured after their first treatment round, and 15 of the 16, or nearly 94 percent, were cured overall. In the vancomycin-only group, four of the 13 patients were cured, and, in the vancomycin plus lavage group, three of the 13 patients were cured.

Ed Yong at Not Exactly Rocket Science notes that the results were so impressive that the team stopped the study early and that all the patients eventually received the treatment.

The treatment is thought to work by altering the composition of the patients' gut microbiome. "The mechanism underlying the efficacy of donor-feces infusion is probably the reestablishment of the normal microbiota as a host defense against C. difficile," the researchers note in their paper, adding that "the fecal microbiota in patients with C. difficile infection had a reduced bacterial diversity, as compared with healthy persons, extending previous observations. Infusion of donor feces resulted in improvement in the microbial diversity, which persisted over time."

Fecal transplants have been used before to treat C. difficile infections, but there have been few controlled experiments, The New York Times adds.

"Those of us who do fecal transplant know how effective it is," Colleen Kelly, a gastroenterologist at the Women's Medicine Collaborative in Providence, RI, tells the Times. "The tricky part has been convincing everybody else."