Faecal transplant effectively treats recurrent or unresponsive Clostridium diff | Hacker News Reader

Faecal transplant effectively treats recurrent or unresponsive Clostridium diff

discover.dc.nihr.ac.uk

106 pointsDanBC49 comments

I have had C Diff. It is extraordinarily unpleasant. In addition to the normal symptoms it also came with extreme fatigue and a weird sense of doom about the future. The antibiotics need to be taken every 6 hours (limiting your ability to sleep) and gave me really creepy dreams. Being stuck with recurrent C Diff sounds miserable and I'm so glad that people in that position have a way out

I don’t want to make you relive the dreams, but can you elaborate on “creepy”?

I have “creepy” dreams or nightmares that ruin restful sleep. They are exceptionally vivid and nightmarish: horrifying scenarios involving people I love, painfully realistic doomsday scenarios, all kinds of death, monsters who look like people but with horrifying deformities...

Think of the most weird fever dream you've had and that is probably similar.

I think one of the stranger fever dream I've had was sometime in college when I was learning about complex numbers, the red standby LED on the TV in my room seemed to be a portal into the complex plane one feverish night.

Having also tried a number psychedelics, fever dreams do have quite a different quality to them.

One time I dosed up on pseudoephedrine to help with a particularly nasty flu, fell asleep, and dreamed I was watching a disturbing cartoon. It was very slapstick and "wacky", like a Tex Avery cartoon, but something was... off about it, and it was horrifying.

Throwaway account -- I had recurrant c-diff for the better part of 2 years. For a while I had accepted that I would just be taking Vancomycin for the rest of my life. Thankfully I was able to get into a study at the U of Minnesota doing transplants. The first one didn't 'stick' and the c-diff repopulated within 6 months, but after the second one I've been clear of it. Horrible stuff. Worsened my Crohn's disease by a large amount.

Ancient Chinese yellow soup!

https://en.wikipedia.org/wiki/Fecal_microbiota_transplant#Hi...

Orally administered, too.

Fluoroquinolone antibiotics (cipro, levaquin, etc) are dangerous and horrific, and irreversibly destroy gut bacteria. This article is about fluoroquinolones, which are well documented to cause C.Diff infections because they destroy most gut bacteria except C.Diff, allowing it to overrun.

I wonder to what extent is Obesity contagious. If you can improve your gut bacteria, surely you can make it worse. Can you pick up gut bacteria from Obese people. Maybe going to the gym helps you lose weight because you touch surfaces and pick up bacteria from fit people. And so on. Just conjecture.

I don’t think obesity itself is contagious (unless you’re mucking about in an obese person’s fecal matter). My hunch is antibiotic usage disrupts your gut biome enough that it pushes your energy extraction balance off, causing obesity.

As a society, we abuse antibiotics in the aggregate (demanding it from health care providers and pouring it into factory farms). It can’t possibly not be disrupting our guy biome.

It also doesn’t help that the sugar lobby/industry is so powerful, and sugar/corn syrup is in everything.

I don't think it's the energy extraction that's changing, but people's set points for weight.

> It also doesn’t help that the sugar lobby/industry is so powerful, and sugar/corn syrup is in everything.

Corn syrup ain't good, but we have fat people in other parts of the world, too.

Rapidly increasing obesity rates seem to be associated with a first world/western diet.

Further investigation seems useful.

Eg anecdotally I can see people in India putting on the pounds much more than Chinese---whether on the mainland or in South-East Asia like Singapore. But I don't know the statistics off the top of my head, I only lived there.

Seems like in the next few years might see some more information about fecal transplants for obesity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045147/

There is ongoing investigation in this area on mother-child transfers of gut bacteria that may influence body weight. The evidence seems to be pointing to diet influencing the type of bacteria that thrive in the gut - so my gut (ha ha) says that a few bacteria entering the gut won’t change things - you need to more or less farm them.

After initial “cure” of Clostridium difficile with antibiotics, about 15-25% of patients develop a recurrence within a few days to several months. The chance of a recurrence depends in large part on the type of antibiotic being taken, such as Flagyl, Vanco, or Dificid, as well as the age of the patient.
This repeat infection can keep on recurring, even after multiple courses of antibiotics. We have seen some unfortunate patients with 10 or more attacks of C. diff in a two-year period. It can lead to chronic diarrhea, weight loss, and diminished quality of life.
We think that recurrence of C. diff depends on a “Perfect Storm” of several factors:
1. Simultaneous failure of the immune system with inadequate antibody formation
2. Failure of the colonic flora to regenerate, owing to exposure to antibiotics.

Failure of the immune system to generate an antibody response is quite common after age 60. The older the patient, the weaker the response to an infection or to vaccination

http://cdiff.in30minutes.com/recurrent-c-diff-why-does-c-dif...

This is a super interesting topic but the cynical side of me thinks it doesn't get enough attention because you can't patent bacteria(?)..

For more on this, checkout the work of Martin Blaser

https://www.youtube.com/watch?v=KwK_O0ahDKo&t=168

I new someone with serious repetitive (daily) diarrhea. Not treatment helped and it lasted for years. Doctors had no solution. Don't know if it was Clostridium Difficile. It started after taking a medication.

One day, a solution was found on Internet. It was to eat cheese made with raw milk. After three months eating various cheese with raw milk every day, the person had no more diarrhea. This has to be done in country with strict health control on cheese production.

Drinking Kefir is easier and better.

I know two people who had serious problems for many years and recovered after doing fecal transplants. Placebo or not, I would recommend it to people who can't be helped by regular medicine. Certainly worth a try.

There seems to be a correlation between gut balance and lifespan, in animal models, [1]. I wonder if a suitable fecal transplant could (somehow) promote longevity.

[1] https://www.sciencedaily.com/releases/2014/01/140116130646.h...

I recall reading a similar clinical trial involving bacterial vaginosis. In BV, vaginal bacteria are imbalanced and thus it was hypothesized that transplanting healthy flora would be helpful.

No it doesnt. Placebo controlled trials show it has no effect. Im surprised at the nhs for this shoddy review.

You mean shitty review?

Would you please stop posting unsubstantive comments to HN? We're trying for better than that here, and I'm sorry to see that you've done it before.

Here's a randomized trial with placebos that did work. I wasn't able to find one where it didn't work.

http://annals.org/aim/article-abstract/2545886/effect-fecal-...

I submitted on a while back. Will check later if people reverse the downvotes and assume good faith.

You'll provide evidence for your claims if people down downvote you for making claims without evidence?

I'm not terribly impressed by that approach.

In my world people ask politely for refs or search for it themselves, rather than downvoting first (which is saying "your comment isn't worth reading").

I got up out of bed, posted a comment and was going to look for the link later if people asked. (I did a quick search and didn't find it). However, from the comments here, it's pretty clear people aren't interested in the science. Carry on...

Is this the post you're referring to?

"There have been a total of 2 placebo-controlled trials into fecal transplants for C.Diff AFAIK. One showed some benefit over placebo, and the other showed no difference."

https://news.ycombinator.com/item?id=10679823#10680173

In case people can't read the article as it's behind a paywall, it's not the primary source. However, to summarize the differences, this one study should not be representative of fact, as it very well could be that in the trial that did not show any benefit, patients could have had very aggressive treatment prior to beginning the study, and thus may have already been clinically cured prior to the study actually beginning. I would definitely trust the OPs meta analysis and systematic review of multiple different trials before believing this placebo controlled trial, for a number of reasons:

1. What I already mentioned above regarding the conflicting results of these two placebo controlled trials

2. The studies used in the nhs article are all done for patients that we're currently undergoing treatment for c diff, not after a long treatment time.

3. Meta analyses and systematic reviews are always going to be higher powered statistically speaking. As long as the papers looked at don't stink of publication bias it's a very valid way of looking at all the research done on fecal transplants for c diff.

The primary source is the one posted above by elsherbini.

I would definitely trust a small negative placebo controlled trial over a large meta-analysis that didn't include any placebo controlled trials, especially for a treatment that has a 90% placebo responder rate (as the trial posted by elsherbini shows).

Why not publish your own meta-analysis, then? Or if not publish, at least write an amateur meta-analysis?

Because I'm not a scientist. And anyway, the reason they didn't include this is because back in July 2016 when this review was written, there were no published placebo controlled trials. The Kelly trial was only published in Nov 2016. Presumably newer meta analyses will take this into account.

But how can you draw a conclusion if you have conflicting results from both placebo controlled studies mentioned? One with a significant difference, and the other without.

That's the study I was referring to. You'll see that there was no difference between donor and placebo in the NY group.

But there was a difference in the other group, right? Isn't that still relevant? The study's authors certainly seem to think so. I've only read the abstract.

Yes, that group had a 40% placebo rate vs the 90% placebo response of the NY group. However it is a very small group, and only marginally significant. It needs a larger, better designed study (preferably one which objectively measures c.diff infection status before and after), but if one study fails to show a response that's a pretty good indication that the treatment is suspect.

Checking the meta-analysis paper on sci-hub, Fig. 2 has 7 RCTs, all of which found large effect sizes. I think you're simply mistaken.

http://sci-hub.bz/http://onlinelibrary.wiley.com/doi/10.1111...

I think you didnt read it. It says there were no placebo controlled trials.

"The benefits, risks, burdens, and effectiveness of the new methods should be tested against those of the best current prophylactic, diagnostic, and therapeutic methods. This does not exclude the use of placebo or no treatment in studies where no proven prophylactic, or therapeutic methods exist." World Medical Association (WMA) Declaration of Helsinki.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2647647/ for more.

Are you familiar with c diff? Placebo's don't work. It's dangerous to have placebo controlled trials with this disease. The current standard of care is a course of very strong antibiotics which still leave > 25% chance of recurrence. These antibiotics are most often used as a control group in c diff infections.

In general, placebo controlled trials are usually conducted for diseases which don't have an effective standard of care, or for conditions which aren't serious enough to be considered life threatening. For more serious diseases where a standard of care exists (standard of care is usually scientifically discovered but validated by placebo controlled trials), you conduct trials and compare the performance of the new drug/therapy with the existing standard of care as the control group.

Yup. It's like wanting placebo controlled trials for cancer. It would be unethical and ungodly harmful to condemn people to suffering and death just so people could gather data that wouldn't even compare the results to the current best practices.

Also the result you care about is often not "does it work?" but "does it work better than the current approach?".

>Are you familiar with c diff? Placebo's don't work

More familiar than you apparently, because placebos have been proven to work:

https://www.medscape.com/viewarticle/853175

I think the problem is the subjective measure, so it's impossible to know which symptoms are caused by c.diff and which from IBS.

Placebo controlled trials for C Diff would be unethical thus would likely not be legal in any country that conduct their trials with any ethical standards. Just like you wouldn't have a placebo group in a trial for an new AIDS or cancer treatment. In this case we're looking for a treatment that works just as well or better than current treatments.

Well clearly that's not true because placebo controlled trials into FMT for c.diff have been done in the USA. AIDS and cancer have objective measures, whereas with c.diff the trials just look at subjective measures.

Also, given that the placebo improvement rates are 40-90% in all c.diff trials, it would be unethical to not use a placebo arm.

Are you thinking of IBS?

No, Clostridium difficile (Kelly et al, 2016, as discussed in the comments above).

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