Fecal microbiota transplantation, or poop transplants, are being used to treat a number of chronic bowel conditions, including ulcerative colitis.
New research out of Australia suggests an effective treatment for ulcerative colitis, a type of inflammatory bowel disease (IBD) that leads to inflammation of the large intestine and the rectum.
The study points to a type of fecal microbiota transplantation (FMT) — yes, poop transplant — that yielded an improvement in people’s symptoms and, in some cases, remission of the disease. This was found in people with mild to moderate ulcerative colitis.
The study, led by doctors at the University of Adelaide in Australia, was published in .
For those unfamiliar, ulcerative colitis is one of the diseases that falls under the broad umbrella of IBD, conditions that lead to chronic inflammation of the gastrointestinal tract.
While Crohn’s disease affects the entire digestive system, ulcerative colitis hits the colon, or large intestine, and the rectum, specifically, .
IBD is widespread, with the CDC that, in 2015, 1.3 percent of adults in the United States — about 3 million people — had a diagnosis of either Crohn’s or ulcerative colitis.
For comparison, just 16 years earlier that number stood at 2 million people.
Ulcerative colitis can range in severity. Symptoms can include bloody diarrhea, abdominal pain and cramps, rectal pain or bleeding, weight loss, fatigue, and fever.
Exact causes remain a mystery to doctors, but you should consider speaking to your physician if you notice changes in your bowel function, including abdominal pain, bloody stool, persisting diarrhea, and fevers that last longer than a day, according to Mayo Clinic.
Ulcerative colitis is serious. People who have this condition are at higher risk for colon cancer.
FMT involves transplanting stool samples from a healthy donor to someone with a condition like ulcerative colitis.
The purpose is to transfer the helpful gut bacteria from the healthy donor so the person with IBD can return balance to their gut microbiome.
In the new study, researchers looked at 73 adults who had mild to moderate active ulcerative colitis. Some of the participants were given FMT that was anaerobically processed, meaning it was prepared in an oxygen-free environment. The others were given their own stool through a colonoscopy, followed by two enemas over the course of seven days.
The FMT that was prepared in an oxygen-free zone led to a 32 percent remission rate for the disease compared to just 9 percent for those people who were given the placebo.
Preparing the samples without oxygen seemed to be key for this treatment.
“Many gut bacteria die with exposure to oxygen and we know that with anaerobic stool processing, a large number of donor bacteria survive so that they can be administered to the patient,” lead author Dr. Sam Costello, gastroenterologist at the Queen Elizabeth Hospital and a lecturer at University of Adelaide’s Medical School, said in a press release. “We believe that this may be the reason that we had a good therapeutic effect with only a small number of treatments.”
Traditional therapies for the condition involve targeting a person’s immune system to reduce inflammation. FMT is significant because it zeroes in on a person’s gut microbiome, the community of bacteria that naturally regulates a person’s gastrointestinal tract, Dr. Benjamin Click, a gastroenterologist at Cleveland Clinic, told Healthline.
“FMT helps restore the normal microbial balance and consequently may reduce inflammation in UC [ulcerative colitis],” Click wrote in an email. “FMT is highly successful for treating recurrent Clostridium difficile [bacteria that causes serious diarrhea] infections, but its role in UC is largely unknown. This study helps shed light on FMT’s potential therapeutic role in UC.”
Dr. Najwa El-Nachef, associate clinical professor of medicine at the University of California San Francisco, said it’s important to note that the benefits of FMT treatments are still in an investigational phase.
“That being said, it is pretty intuitive that this would be helpful in treating conditions that affect the gastrointestinal tract,” El-Nachef told Healthline. “For ulcerative colitis, inflammatory bowel disease, in general, there is an imbalance of bacteria of the gut, a dysbiosis, where there is a change in the milieu of bacteria in a person’s gut. This most recent study shows that, at least for a subset of people, this treatment is going to be beneficial. Exactly how? We don’t know for sure yet.”
She said more investigations into FMT could potentially lead the way to better understand how manipulating microbes in the gastrointestinal tract could lead to new routes for controlling and clamping down on rampant inflammation caused by conditions like ulcerative colitis.
This certainly isn’t the first study to look at the impacts of FMT.
A 2016 review in highlights past research on FMT and its perceived health benefits. It cites not only FMT being used to treat IBD and C. diff infection, but also obesity and metabolic syndrome.
The authors of the review caution that, while many studies point to the benefits of this treatment, there are some reasons for concern.
“There are fears of the infectious potential of the therapy. Few long-term studies have been undertaken to assess the safety of FMT and the theoretical risk remains. This has led research groups to explore the use of ‘synthetic stool’ products with defined bacterial populations to ameliorate such concerns,” the authors wrote.
In 2013, the Food and Drug Administration (FDA) announced that FMT satisfied its definition of a “drug” or “biologic substance,” and right now, the agency permits physicians to use it specifically for C. diff infection.
The FDA requires doctors to file for an investigational new drug (IND) application to treat other gastrointestinal and non-gastrointestinal disorders, according to a .
This study’s focus on how the FMT was prepared is what sets it apart.
“Many bacteria living in the gastrointestinal tract thrive in an oxygen-free (anaerobic) environment and struggle to survive when exposed to an oxygen-containing (aerobic) situation. Previous FMT studies exposed the stool to oxygen during processing, potentially killing many of the anaerobic bacterial species,” Click wrote.
He added that oxygen-free processing mimics what would happen in an actual environment of the gastrointestinal tract. He said this process could help maintain the normal bacterial diversity of the gut throughout the FMT process.
“Maintaining this diversity may improve the clinical effect of FMT,” he wrote.
Interest has been high surrounding this study. Already, a UK-based company called Microbiotica has made an agreement with the researchers to develop an actual therapeutic based on the FMT used in this study.
In the release, lead author Dr. Costello said that the end goal would be to have microbial therapies that would replace FMT.
This could include a “bacteria pill” that could carry out the same benefits of these stool transplants, but that would be safer and less cumbersome.
These researchers now plan to investigate whether FMT treatments can maintain long-term remission of ulcerative colitis in patients.
El-Nachef said that she understands that, for people with IBD, news of this kind of research is “exciting.”
She said that people eager to explore this kind of treatment should never try to do any kind of transplant on their own.
“It’s still investigational,” she reiterated. “If they are interested, they should seek sites that perform clinical trials in a controlled fashion.”