“Poop Pill” Offers a New Option to Treat C. Diff Diarrhea

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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You may have heard about “fecal transplants” for the treatment of Clostridium difficile (C. diff) infection. Clearly, there is a yuck factor involved in having an emema of someone else’s stool but this treatment may be life altering and even life-saving for folks with C. diff diarrhea.
Now, there is another option: yes, a poop pill.
What is a fecal transplant?
Typically, fecal (stool) transplants, using feces from healthy donors, are delivered by enema, colonoscopy or a tube through your nose to your stomach (a nasogastric tube).  The result of fecal transplant is a rebalancing of the bacteria in the gastrointestinal system of patients with recurrent C. diff infections.
How can a pill help—and why is it even an option?
Now several studies have confirmed that a stool capsule is just as effective.  In one study, the pill formulation was 100% effective in the first 32 patients treated, when checked at a 3-month follow-up. Some of those patients have been followed for up to 3 years since that check, and they remain C. diff-free.
A more recent study (November 2014 JAMA) demonstrated that taking stool capsules orally had an overall rate of resolution of diarrhea of 90% in patients with C. diff. Those rates are the same as fresh stool transfers, which is excellent news. It does take a little longer for symptoms to resolve with the capsule though: 4 days vs 2 days.
How do you make this pill (and do I want to know)?
It’s complicated. Stool from donors is packaged into a capsule utilizing concentrated cryopreserved fecal-derived bacteria and is given orally to patients. In studies, it is generally shown to be an effective, safe and well-tolerated therapy for recurrent c-diff—and so much better than the alternative.
Dr. O

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