Fraser Health halts planned fecal transplants
Fraser Health has halted plans for an unusual treatment of implanting feces into patients threatened by potentially deadly infections after the federal government objected.
Fecal transplants are thought to be a way to introduce healthy gut bacteria that can crowd out and replace dangerous bacteria such as C. difficile. Stool from healthy patients can be added via enema or a tube down the throat.
Doctors at Burnaby and Ridge Meadows hospitals were to provide the therapy to patients whose recurring C. difficile infections haven't been cured by antibiotics and have battled chronic diarrhea.
The physicians have argued fecal transplants are effective and could have saved the lives of multiple patients who died of C. difficile infections at Lower Mainland hospitals in recent years.
Health Canada, which considers the treatment investigational, recently stated it can only be performed within clinical trials, which it has authorized in other provinces but not in B.C.
Dr. Elizabeth Brodkin, medical director of infection prevention and control at Fraser Health, said Fraser has put the pilot project on hold in response but she still strongly supports the concept.
"We are fully committed to bringing this procedure to our patients in the near future as we know it can save lives," Brodkin said in an emailed statement.
Fraser didn't believe fecal transplants would be considered an experimental drug limited to clinical trials until it got notification from Ottawa.
"We aren’t considering a clinical trial for this procedure, as we feel there have been sufficient clinical trials to show that this treatment is safe and effective," Brodkin said.
She said the health authority first confirmed that the College of Physicians and Surgeons of B.C. had no objection to physicians using the treatment.
Brodkin points to a European trial that was halted early after it cured 94 per cent of C. difficile diarrhea sufferers compared to 27 per cent for the powerful antibiotic vancomycin.
The findings, reported in early 2013 in the New England Journal of Medicine, concluded it was significantly more effective than antibiotics – three to four times more likely to cure the infection.
Fraser Health's first fecal transplant was performed in 2010 at Burnaby Hospital by Dr. Jeanne Keegan-Henry.
Fraser Health's own newsletter hailed Keegan-Henry for pioneering the procedure in an article titled "The S**t Disturber."
It recounted how she bought a blender, labelled it 'Don't use for food' and churned up a diluted mix of a healthy donor's feces that she then implanted via colonoscopy into a C. difficile patient who was near death.
A second implant was performed a year later by Maple Ridge Dr. Ed Auersperg but officials ordered a halt as they hadn't been approved.
The health authority reconsidered the issue last year and decided to pursue the new pilot. Donors would have been screened to prevent the spread of diseases – the main cost of the procedure.
Keegan-Henry told the newsletter the "ewww" factor is the main objection, but not usually from patients.
"By the time you've had diarrhea for two to three months, if someone says 'I'm going to do something absolutely disgusting to you and within an hour you will stop having diarrhea and you may never have it again' you'd be surprised how little resistance there is."
She described the fecal implants as a "cheap and easy" fix to an awful "heartbreaking" disease that incapacitates victims for months and kills some of them.
"I don't have any doubts this will save lives."
Fecal transplants have gained attention in recent years as a potential treatment for other intestinal disorders as well.