Cape gut doctor puts poo to good use against life-threatening illness

25 October 2015 - 02:00 By CLAIRE KEETON

A Pioneering doctor is transplanting faeces in Vincent Pallotti Hospital in Cape Town with great results. Taking stool from a healthy donor and putting it into the patient has cured more than a dozen people from a life-threatening infection. Dr Dave Epstein is one of a handful of gastroenterologists in South Africa who perform faecal transplants, which have been proved in scientific trials to have an 85% success rate compared with 20% for standard antibiotics in treating the severe diarrhoeal infection Clostridium difficile.More than 7000 faecal transplants have been done worldwide and they seem safe, but the long-term effects are unknown.The power of gut microbes, found in stool, is an exciting field of research; however, "claims that faecal transplantation could be the cure-all for many diseases are probably too optimistic", the British Medical Journal stated this week.Tim Spector, professor of genetic epidemiology at King's College London and author of The Diet Myth: the secret behind what we eat, and an American colleague wrote the article.Gut microflora play a vital role in intestinal health and immunity and may also potentially influence body weight or mental health.story_article_left1Anecdotal reports show two people became obese after faecal transplants and some mice became malnourished after getting faeces from malnourished children.Spector said: "No one is sure if the two case reports were due to chance, their genes or the transplant, so it remains a possibility and all donors should be slim and have no family history of obesity."The potential transmission of anxiety and depression was worrying, since gut microbes produces neurochemicals in animals, the editorial warned.Cape Town paediatric gastroenterologist Dr Shrish Budree, who is doing microbiome research at Massachusetts General Hospital in the US, said small studies of faecal transplants in children with ulcerative colitis had shown some promise, but bigger trials were needed.The greatest risk of transplants is transferring unknown viral or fungal infections to a patient.South Africa has no bank of frozen stool - unlike the US, where about 500 centres offer faecal transplants - and so a healthy, screened woman has stepped in as one of the donors for Epstein's cases. "The wife of a patient donated and when I had another patient who could not find a relative, she donated again and has done it a few times since then."A capsule is likely to be released in the next year or two to do the same as a stool transplant - reseeding the gut with beneficial microbes. Epstein said: "It is an ancient Chinese remedy which is coming back and has proved effective."He does transplants - from the top down through a tube or the bottom up through a colonoscopy - to treat Cdifficile only after two rounds of antibiotics have failed. This infection kills thousands globally and it is becoming more common in South Africa."More and more people are taking powerful antibiotics, which wipe out their flora and becoming prone to Cdifficile," said Epstein, who lectures part-time at the University of Cape Town."I started faecal transplants in 2013 and every patient got better except for the first time, and that worked when it was repeated. I have treated about 15 people and one four-year-old."

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