Bonnie Wortmeyer has spent the past few years plagued by ill health. Among the major issues she has had to deal with are a double lung transplant and what she calls her “poo transplant”, which she says changed her life.
While recovering from her double lung transplant, Wortmeyer was exposed to numerous courses of antibiotics, which made her susceptible to contracting the Clostridium difficile bacteria. C diff, as it’s known, is a nasty, life-threatening bacteria which makes life almost unbearable for its sufferers.
For Wortmeyer, in her late 50s when she was attacked by C diff, it meant constant diarrhoea and debilitating stomach cramps.
“I’m not exaggerating, I thought I was going to die,” she says. “I couldn’t eat anything without it going straight through me. I couldn’t hold anything down and it was almost like before I left the table I had diarrhoea.”
A few years later, Wortmeyer broke her leg and was once again in hospital, with large doses of antibiotics administered. This hospital visit brought her into the path of gastroenterologist Dr Sam Costello, the founder of Australia’s first public stool bank, BiomeBank in Adelaide, in 2013, which he now runs with Dr Rob Bryant.
Costello prescribed a faecal transplant for Wortmeyer, who felt the effects of the treatment within hours.
“I think it was instant,” she says. “I had to wait an hour after the procedure to use my bowels and, from that moment on, I was absolutely fixed.
“Dr Costello told me if I hadn’t had the poo transplant, they would have had to remove a huge part of my bowel and I’d have a colostomy bag.”
Wortmeyer is one of thousands of patients around the world finding freedom from the disabling symptoms of C diff through faecal microbiota transplantation, which is the medical term for “poo transplant”. Studies show that faecal transplants have an 80% success rate in treating C diff and many patients feel better within hours, just as Wortmeyer did.
The gut’s microbiome is the bacteria, funghi, viruses and other organisms that line the intestines. This ecosystem does a lot – including acting as a protective barrier for the immune system, producing vitamins, breaking down food and even encouraging healthy brain development.
Antibiotics come through that system and not only wipe out the disease or germ they’re there to kill but often a lot of the other healthy bacteria the body needs to function. It’s here where faecal transplants can help, by repopulating the microbiome with the bacteria of a healthy person.
FMT is a relatively simple procedure. When done through a reputable medical facility, it involves the dilution of donated faecal matter with saline, and the insertion of the faecal matter into the patient via enema, colonoscopy, nasoenteric tube or pills.
Due to inconsistencies between states in the collecting of records, the true extent of C diff infection in Australia isn’t known, however a 2018 report on the burden of C diff in Australia by the Australian Commission on Safety and Quality in Health Care estimates there were 113 cases of severe disease nationally and that 45 people died of severe C diff infections in 2015.
There’s yet to be a national registry of exactly how many Australians are having faecal transplants but, in South Australia, it’s about 30 per year.
What was laughed at in the medical industry as recently as 10 years ago is now a field of medicine being rigorously trialled as a solution to all sorts of conditions from inflammatory bowel disease to depression and obesity. While many clinical trials are happening in Australia and around the world, faecal transplant is only approved in Australia for the treatment of the C diff infection. There’s evidence faecal transplant could bring ulcerative colitis into remission but this treatment is currently being reviewed by the Therapeutic Goods Administration, with medical professionals working on guidelines on how to regulate it.
“Clostridium difficile is an organism that can overgrow in the bowel after a person’s native bowel flora are eliminated, often due to antibiotics,” Bryant says. “The faecal transplant contains large numbers of beneficial microorganisms, which out-compete with C diff in the gut ecosystem and prevent it from multiplying in the bowel.”
One of the major challenges in the faecal transplant industry is availability of medicine. That is, the availability of the amounts of poo needed to make the procedure more widespread.
Costello and Bryant take Guardian Australia through the rigorous process of being a donor, where less than 10% of possible donors make the cut.
“We have a standard screening process where people first have a medical interview, set questions that they answer regarding any medical problems that they have, or risk factors for medical problems,” Costello says. “This would be similar to those questions which you would ask a blood donor.
“There are some additional questions because we think that the potential risk of disease transmission by faecal transplant may be different to the risk of disease transmission for blood donation. If donors pass this, they would then have a limited physical examination, a blood test looking for predominantly infective risks but also some metabolic risks, and a stool test for infections. If they pass all of those stages, then they could become a stool donor. We would do testing both before a period of collection and after the period of collection to ensure that no new infections during the donation period.”
There is a potential risk for disease transmission with faecal transplants, which is why donors are so heavily screened. But other risk factors also exist.
“There’s evidence from animal studies that you can transmit a tendency to obesity with faecal transplant,” Bryant says. “Although these studies were only conducted in mice, it’s not well shown in humans, but we believe that there may be a risk of transferring metabolic problems such as obesity with FMT.”
The average FMT treatment requires 50g of faeces to perform and the average faeces donation is around 100g. The clinic encourages donors to bring their donation in as fresh as possible – on the way to work, for example.
“Also,” Bryant says, “We have a wonderful, squeaky clean toilet here at the stool bank and are always after more premium stool.”
After the rigorous screening process, donors are paid $25 for every poo they drop off to be further screened for use as medicine.
Dr Craig Haifer is a Sydney-based gastroenterologist who is researching for his PhD whether FMT in pill form will be effective treatment for patients with inflammatory bowel disease. Unlike C diff, inflammatory bowel disease is chronic, and affects people mainly in their 20s and 30s, setting them up for future health issues.
He is doing one of thousands of studies around the world in FMT and is also hoping to set up a list of guidelines for the use of faecal transplants in Australia, as the service continues to grow.
“Australia’s a bit of a world leader when it comes to FMT,” Haifer says. “The field is moving so rapidly. We’ll use it down the track in some way or form a lot more than we do now, so it’s a pretty exciting area.”
The need for FMT to treat C diff alone is rapidly expanding with our ageing population and the medical world’s use of antibiotics.
So it’s no surprise that 12 months after her first “poo transplant”, Wortmeyer found herself with another flare-up of the bacteria.
“I was all fine for a good 12 months, then had to go back to hospital with chest infection,” Wortmeyer says.
Multiple rounds of antibiotics saw the C diff return to her and the bowel problems returned.
“I had another poo transplant,” she says. “The second time, it took about a week before it settled again.”
She hopes another round of antibiotics won’t bring it back but cannot believe how unknown the procedure is, especially as it has been so instantly effective for her.
“When I had my first poo transplant, which wasn’t that long ago, it was amazing how many doctors didn’t even know about it,” she says.
