How many would agree to a fecal enema?

John Dillinger, the notorious bank robber, was once asked why he robbed banks.

DR. GIFFORD JONES

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 complaint.

We have millions of bacteria living in our large bowels, usually not making war with one another. Studies show 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. 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.

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 every year three million North Americans develop C. difficile infections.

The diagnosis is made by examining a stool 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 pain, diarrhea and skin irritation.

So what do you do if all treatment fails and C difficile results in up to 40 bowel movements daily? Some doctors have use the ‘fecal transplant’ or more to the point, the fecal enema. This approach is not without controversy.

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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