Faecal transplant safe for gut treatment, says watchdog

Around a third of adults have harmless C. difficile bacteria in their gut

A treatment using faecal matter is a safe and effective procedure for people with a recurring gut infection, the NHS medicines watchdog has said.

The National Institute for Health and Care Excellence (NICE) has published guidance on using the transplant procedure to treat repeated Clostridium difficile infections.

C. difficile, caused by an imbalance of bacteria in the gut, can be deadly.

Faecal transplants could be used where antibiotics have failed, NICE said.

C. difficile bacteria live harmlessly in the lower intestine of about one in 33 healthy adults.

Infections occur when an imbalance of bacteria develops, allowing the number of C. difficile bacteria to grow and produce toxins.

Symptoms include vomiting, diarrhoea and abdominal pain.

While it may be a mild infection, it can lead to serious complications such as sepsis and perforation of the bowel, and can prove fatal.

C. difficile is most commonly acquired in hospital, but there are an increasing number of cases in the community.

'Restores balance'

Antibiotic treatment is usually successful, but for about one in four people, the symptoms return and they can suffer repeated infections.

In 2011 there were 17,414 cases of C. difficile in England, down from 52,988 in 2007. Three-quarters of cases are in the over-75s.

C. difficile can cause severe abdominal pain

The faecal microbiota transplant involves putting healthy donor faeces into the patient's gut.

This restores the balance of bacteria and prevents further relapses.

Prof Bruce Campbell, chair of the Interventional Procedures Advisory Committee at NICE, said: "The procedure involves taking a stool sample from a donor [often a family member].

"The stool is screened to ensure there are no potentially harmful bacteria in it and then it is diluted it with fluid and put into the patient's gut.

"That can be done through a fine tube inserted into the gut through the patient's nose, or via a telescope inserted through the anus.

"The healthy donor stool helps to stimulate the growth of 'good' bacteria, restoring the body's natural balance."

He added: "It doesn't sound pleasant, but the evidence shows that it is safe and effective for four in five people with recurrent C. diff infections."

'Aesthetic' problem

NICE looked at seven studies of the faecal transplant procedure, involving 558 people.

It found nearly all the patients were cured.

Dr Alisdair MacConnachie from Gartnavel General Hospital in Glasgow, who has pioneered the treatment, said he was "delighted" that NICE had looked at the treatment.

He said: "Faecal microbiota transplant is a relatively new procedure so I welcome this NICE guidance, which provides clear advice to doctors.

"I offer this treatment to patients who have had multiple relapses of C. difficile and in my experience it is highly effective.

"Out of the 35 people in whom I have carried out this transplant procedure, over 90% have been treated successfully."

He added; "It would be ridiculous to suggest that it doesn't suffer from 'aesthetic' problems.

"But I think if you're a patient who has had multiple recurrences of C. difficile, your perception of what makes you squeamish is probably different to people who haven't.

"They are more concerned about getting rid of C. difficile."

"Moreover, patients understand and accept the basis for this treatment with many patients requesting the treatment from the doctors treating their C. difficile thus prompting referral to myself. "