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New evidence suggests there’s a much easier way to get a fecal transplant

Fecal transplants are an increasingly useful treatment for a range of ailments—but getting one is not a pleasant process. Now new research into the treatment of Clostridium difficile suggests there may be a much easier way to replenish the beneficial bacteria of the gut that’s just as effective: fecal pills, which are simply swallowed.

C. diff is a nasty, toxin-producing bacteria that usually lives in small numbers in the gut. In most healthy people, it’s not much of a threat—trillions of other microbes keep it at bay by out-competing it for for space and food. But for patients fighting off other infections, C. diff, can be life-threatening.

Powerful antibiotics administered to treat other infections wipe out all these other bacteria, allowing C. diff to reproduce with abandon. When it does, the toxins it produces can cause bouts of diarrhea and painful intestinal inflammation. Even when more antibiotic treatment can keep it at bay, C. diff infections (CDI) recur about 20% of the time—and can be fatal. Currently, about 500,000 people in the US become ill with CDI, costing the country almost $5 billion.

Four years ago, scientists published data from a clinical trial that found that fecal transplants were more effective at treating CDI than more rounds of even more potent antibiotics. These transplants take a slurry of stool from a healthy donor, and repopulate the gut with a whole new colony of bacteria, rather than trying to eliminate them with antibiotics. The new colony of bacteria once again prevents the C. diff from running rampant. It has become a fairly common treatment—especially in cases where patients have multiple bouts of CDI after treatment (although it isn’t officially approved by the US Food and Drug Administration for this use).

There’s just one problem: getting a fecal transplant is usually pretty invasive and unpleasant.

Getting the right microbes to the right place usually involves a colonoscopy, which is a procedure where the patients is sedated and a delivery tube is inserted through the anus. Sometimes the microbes are delivered through a feeding tube inserted via the nose into the small intestine. Neither of those procedures are particularly pleasant, and both come with their own set of risks, Time reports, including poking holes in the intestines or getting fecal matter in the lungs. Still, the prevalent thinking among doctors was that this was the best option for treating some patients.

A new study suggests that this may not be the case. On Nov. 28, researchers led by a team based in Canada published the results of a clinical trial where they compared the results of 116 patients who had recurrent CDI (that came back at least three times), and were either treated with a traditional colonoscopy fecal transplant, or given fecal transplant pills instead. They found (paywall) that pills worked just as well as a colonoscopy delivery of the transplant, curing over 95% of patients in both cases after 12 weeks. Perhaps more importantly, 66% of patients who took pills reported that the experience was “not at all unpleasant,” compared to just 44% of patients who didn’t find the colonoscopy unpleasant.

“I think with this study, we can see that maybe the capsule delivery format is the way to go if you are going to give this type of microbiome-based therapy,” Dina Kao, a gastroenterologist at the University of Alberta in Canada and lead author of the paper, told Time.

The trial didn’t include a placebo group, and it wasn’t blinded. (Practically, it would be pretty obvious to patients whether they were taking 40 pills with water, or being sedated to have a tube inserted anally.) Because of those methodological limitations, researchers need to do more studies to make sure that these results stand up.

In any case, these are promising results that open the door to using pills to give fecal transplants for all sorts of other kinds of health conditions, too, including malnutrition. Considering that most patients who receive these types of transplants are very sick already, making the treatment less risky and more tolerable is ideal.

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