Stool transplant: 3 patients tell why they did it and how it happened – 08/01/2022

Stool transplantation. That’s right, you read that right. It may sound strange when you hear it, but it’s more common than you think. Treatment is indicated when patients have a severe imbalance in the gut microbiota, primarily caused by excessive use of antibiotics throughout life.

Microbiota it is the set of bacteria, viruses, fungi, parasites among other microbes and their respective genes, which are present, in this case, in the intestine.

The inflammation caused by too much of this type of medicine, called pseudomembranous colitis, occurs in the large intestine, causing diarrhea and severe abdominal pain, caused by bacteria called Clostridium difficile. This type of transplant, technically called faecal microbiota, is authorized by the Ministry of Health and can be performed by the SUS (Unified Health System).

Wrong diagnosis and too many symptoms

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alago’s patient NSA*28 years old, has heart disease Crohnsa syndrome that affects the digestive system and has symptoms of abdominal pain associated with diarrhea, fever and weight loss. She was diagnosed at age 22.

”It was very difficult to arrive at the diagnosis. I went through several doctors, I even received a wrong diagnosis and I ended up in the hospital, I was very sick,” says the woman, who prefers not to be identified.

Until the first half of 2021, the young woman was taking expensive immunosuppressive drugs to alleviate the symptoms of the disease. “I used to inject three vials of the drug every eight weeks,” he recalls.

In September of the same year, Is it over there was one of the volunteers to participate in tests with the transplant of the microbiota fecal. The procedure took place at the Professor Alberto Antunes University Hospital, of UFAL (Federal University of Alagoas), under the supervision of Manoel Álvaro Lins Neto, proctologist.

”Since I had the stool transplant, I no longer take any medication and I am doing very well. I am satisfied with the result,” she said.

Motivation: blood in the stool

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the official RFS*48, was also one of the patients to undergo a liver transplant. microbiota fecal in Maceio. He was diagnosed with retrocolitis ulcer disease at 37, a chronic inflammatory disease, which mainly affects the large intestine (colon).

”I had severe pain in my stomach, but what motivated me to seek medical attention was when blood appeared in my stool. I was hospitalized for 11 days, with a fever and on antibiotics. That’s when they diagnosed the disease,’ he said.

Before doing the fecal transplant, the official used a drug to reduce the inflammatory process in the intestine. In mid-August 2021, before the transplant, he had to stop injecting himself with medication.

”Since then, I haven’t taken any medicine to treat the retrocolitis ulcerative. I lead a normal life and I believe the transplant had a very meaningful result,” he says. By the end of the year, he will undergo another fecal transplant to reinforce the treatment, which is still under study. experimental.

Bathroom 15 times a day

Pedro Schestatsky - Personal Archive - Personal Archive

For Pedro, the fecal transplant did not achieve the expected success

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Year 2018, Peter Shestatsky48-year-old neurologist from Porto Alegre was diagnosed with irritable bowel syndrome, a disorder characterized by abdominal discomfort, pain, diarrhea and constipation.

”I used to go at bathroom about 15 times a day. It was a very difficult life. So I read scientific articles on the exchange of microbiotawhich improves the patients’ symptoms, and I decided to have a stool transplant,” explains the doctor.

At the time, the procedure was performed at Ernesto Hospital Dornellesin the capital of Rio Grande do Sul, under the command of gastroenterologist Guilherme Becker Sanderhead of the establishment’s endoscopy department.

Shestatsky explains that the doctor took feces from a vegan donor, and later the feces were placed in a mixerwhich ended up creating a pasty liquid [aos cuidados de um microbiólogo].

”This substance was inserted into my body during a colonoscopy and I felt better for three weeks, but then everything went wrong and I got worse,” said the neurologist, who hasn’t changed his eating habits, an important part of treating the syndrome.

The gut-brain axis

brain-gut relationship;  gut microbiota - iStock - iStock
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Here in Brazil, the first stool transplant took place in 2014 at the Israelita Albert Einstein Hospital, in the city of São Paulo, and it was to treat colitis. In 2017, the Hospital das Clínicas of the UFMG (Federal University of Minas Gerais) was a pioneer in the creation of a faecal microbiota transplantation center and, in addition, in the management of a stool bank.

According to Daniel Antônio de Albuquerque Terra, gastroenterologist and endoscopist, who works at the centre, ”faecal microbiota transplantation has a well-established indication only in cases of recurrent or refractory intestinal infection by the Clostridium difficile”.

However, with advances in research, the procedure has been studied as a possible treatment option for other conditions and may help patients with inflammatory bowel disease, cirrhosis liver disease, irritable bowel syndrome and even neurological disorders such as multiple sclerosis, Parkinson’sautism and the Depression.

”Despite all this enthusiasm, caution should be exercised in its use, given the paucity of long-term safety data”, emphasizes Terra.

According to the gastroenterologist, 17 clinical trials are currently being conducted in North America, Europe and Asia on the transplantation of fecal microbiota in patients with obesityamong other illnesses.

”However, the evidence is not strong to indicate transplantation in this scenario and more research is needed to produce the desired scientific knowledge. The same goes for neurological diseases: there are preliminary indications of benefits, but there is still no conclusive evidence to indicate transplantation as a routine treatment,” warns the researcher.

In Maceió, at the Professor Alberto Antunes University Hospital, 21 patients with inflammatory bowel diseases have been performing, since August last year, the gut microbiota transplant, in the case of the two people mentioned above.

“In these cases, we did the transplant for inflammatory bowel disease – ulcerative colitis and Crohn’s disease. There was no longer any possibility of surgery, so I proposed a microbiota transplant to these patients. We are closely following the developments of this treatment alternative. We cannot yet say results, because it would be hasty and all research is accompanied by optimism followed by ethics and precaution, ”underlines Lins Neto.

Hippocrates, considered the father of medicine, had already observed that the origin of all diseases was the intestine. Thus, it is not surprising that cases of imbalance of bacteria in the microbiota have been identified in people with psychiatric and neurological disorders. The activity of your gut bacteria affects stress and anxiety – a balanced microbiome can improve how you handle stress, but an unbalanced microbiome can affect your mental health, for example.

After the stool transplant, Shestatsky realized that the intestine is one of the most important organs in the human body. ”It’s our body’s inflammation portal, the defense system [imunidade] everything is inside. It is the intestine that absorbs nutrients and determines whether the person will be diabetic or not. There is a very strong relationship between the degree of bacterial diversity that the patient presents with cancer, asthma, Parkinson, autism. It’s a golden organ, as precious as the brain, and it’s a neurologist who says so,” says the gaucho.

lack of donors

One of the major problems in faecal microbiota transplantation is finding a donor. Brazilian society still does not have this culture of excrement donation, and carries with it mistrust and lack of information. Another difficulty is finding a poo compatible with the receiver.

To be a donor, the candidate is subject to very strict criteria in which, in addition to blood tests, lifestyle, eating habits, physical exercise, the absence of gastrointestinal symptoms and infections, and non-use of antibiotics in the four months prior to collection.

”Out of 70 volunteers questioned to give faeces, only five were classified, among them, all women”, comments the doctor from Alagoas.

If you are interested in being a donor, find a research center, university, hospital or laboratory in your city that works with fecal transplantation.

*Patient names have not been used to protect their identity.

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