How many would agree to a fecal enema?

John Dillinger, the notorious bank robber, was once asked why he robbed banks. He replied, “That’s where the money is.” Today, if you asked infectious disease experts where Clostridium difficile resides, they would reply, “It’s in hospitals. It’s dangerous and can be lethal.”

Other experts might warn that many C difficile infections could be avoided if North Americans would stop looking for pills to treat every human complaint.

Rather than seeking pills they should be following a healthy dietary lifestyle. In fact, getting smart could even save 40 bowel movements a day, and, at times, a life.

We have millions of bacteria living in our large bowels, usually not making war with one another. Studies show that about 3% of adults and 70% of healthy infants have C difficile in their intestines.

But when antibiotics are prescribed to treat pneumonia, ear infections, bladder or sinus infections, they often upset the balance of power between bacteria. This allows C difficile to increase and produce a toxin that causes diarrhea. The same result would happen if hunters killed all the wolves and allowed the deer to multiply. It’s always dangerous to fool around with the balance of nature.

C difficile has become a major problem for hospitals. Today, there’s increased likelihood of developing this infection in hospital if you are elderly, have a suppressed immune system or are being treated for a malignancy.

Several studies also show a link in patients who are taking proton pump inhibitors (PPIs) such as Nexium, Losec, Prevacid, Pantoloc, Pariet and Tecta. These drugs are best used to treat patients suffering from recurrent acid reflux disorders.

But Dr. Lauren B. Gerson, a gastroenterologist at the California Pacific Medical Center in San Francisco, says that PPIs are often the first thing doctors give patients for heartburn. That’s like shooting a mouse with an elephant gun. Patients suffering from run-of-the-mill infrequent heartburn don’t need PPIs. Rather, they should first try over-the-counter remedies such as Rolaids, Tums, Mylanta and Maalox. If these antacids fail, drugs such as Pepcid AC or Zantac 75 are available that have fewer side-effects and are also less expensive.

Because of the use of the elephant gun to treat heartburn, along with the general overuse of antibiotics, C difficile is no longer a rare problem.

A report in the Journal of Pediatric Pharmacology claims that 15-20% of patients receiving antibiotics develop antibiotic diarrhea.

Another report from the Mayo Clinic says that every year three million North Americans develop C. difficile infections.

The diagnosis of C. difficile is made by examining a stool sample to detect its presence or its toxin.

Treatment in most cases is to discontinue the offending antibiotic. This allows normal bacteria in the bowel to recover and is successful in about 25% of cases. Or other antibiotics may be needed in an attempt to kill C. difficile. But in spite of treatment about 10 to 20% of patients have recurring bouts of disabling pain, diarrhea and skin irritation. And during an epidemic of this infection in Quebec, 700 people died.

So what do you do if all treatment fails and C difficile results in up to 40 bowel movements daily? As a last resort some doctors have resorted to the ‘fecal transplant’ or more to the point, the fecal enema. This approach is not without controversy. As you might expect, some physicians have poo-pooed the idea! Or have facetiously asked their colleagues how much they have to pay for the poo.

But if you are seriously ill, and may die from the infection, it’s no laughing matter. Fecal donors are usually parents, spouses, siblings or relatives and the stools are tested to rule out hepatitis infection, HIV and screened for parasites and C difficile.

The first fecal enema was given by a Dr Thomas Louie, head of infectious disease at Foothills Hospital in Calgary in 1996. Since that time the procedure has been carried out in other countries. Some authorities claim a success rate of 89%.

It appears that critics may have to stop poo-pooing the idea.

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