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Researchers are looking at a capsule as an alternative to surgery for fecal transplants. Mustafa Ciftci/Anadolu Agency via Getty Images
  • Research out of Europe shows that fecal transplants may be an effective treatment for people with end-stage chronic liver disease.
  • The transplants work by replacing “bad” bacteria in the gut microbiome with “good” bacteria from a healthy donor.
  • Fecal transplant pills have been approved in the United States to treat C. difficile infection.
  • In addition to the cirrhosis research, there are a number of other potential applications for fecal transplantation.

New research into fecal transplants may turn out to be a game-changer for people with chronic liver disease.

A team led by King’s College London is set to begin a clinical trial there — known as the PROMISE trial — after promising results from an initial trial, known as the PROFIT trial.

The findings from the PROFIT trial, which haven’t been published yet in a peer reviewed journal, were announced today at the 2023 EASL (European Association for the Study of the Liver) Congress in Vienna, Austria.

While the viability and health benefits of fecal transplants have long been known, researchers involved in the trial say they hope their data will lead to alternative treatment options for people with cirrhosis.

Dr, Daniel Freedberg is a gastroenterologist, internal medicine specialist, and assistant professor of medicine and epidemiology at Columbia University’s Mailman School of Public Health in New York as well as a member of the scientific advisory council of the Peggy Lillis Foundation.

Freedberg, who is not involved in the clinical trial, told Medical News Today that records of fecal transplants go back centuries.

“More recently, we have two decades of experience using fecal transplants for recurrent Clostridioides difficile (C. difficile) infection,” he explained. “Fecal transplants take stool from a healthy individual and put it into a sick individual. The idea is that normal, healthy gut bacteria will replace the damaged gut bacteria and help to restore health. Fecal transplants can be done via pills, upper endoscopy, colonoscopy, and emema. All of these ways of delivering fecal transplants are effective.”

While each method may be effective, the investigators involved in the PROFIT trial found that patients preferred taking a pill to the other, more invasive methods.

“Patients told us that they would prefer to take tablets rather than have the fecal transplant administered by an endoscopy,” Debbie Shawcross, the chief investigator of the PROMISE trial and a professor of hepatology at Kings College London, said in a statement.

“The ‘crapsules,’ as they are sometimes nicknamed, which have none of the taste or smell as the name suggests, may offer new hope for patients with cirrhosis who are out of treatment options,” she said.

The researchers reported that the capsules — full of freeze-dried stool rich in “good” bacteria — were effective in replacing the “bad” bacteria that’s present in the bodies of people with cirrhosis of the liver.

While more data is needed, fecal transplants could someday be a treatment option for people who would otherwise need a liver transplant.

“Initial findings from the PROFIT are promising news for patients with chronic liver disease who are in desperate need of alternative treatment options that may overt the need for liver transplantation,” said Shawcross.

Dr, Kelly Johnson-Arbor, a medical toxicology physician and medical director at National Capital Poison Center in Washington, told Medical News Today that the U.S. Food and Drug Administration (FDA) approved the first oral fecal transplant pill for use in humans earlier this year.

With an increasing number of potential applications and administrations, it’s important to ensure that any fecal transplants are done under close medical supervision, she cautioned.

“People who use do-it-yourself fecal transplants typically source their fecal transplants from friends or relatives,” Johnson-Arbor explained. “These procedures do not involve stringent stool screening or processing methods, carry the risk of infectious disease transmission between donor and recipient, and are not proven to be safe or effective.”

To contrast with these DIY methods, Johnson-Arbor says, commercially available fecal transplant pills are sourced from samples that have been carefully screened and filtered.

For those who have problems in their gut microbiome, a safe fecal transplant can be effective at treating C. difficile. While more research is needed, the PROFIT trial shows a potential alternative application for fecal transplants — one of several.

“Currently, oral fecal transplant pills are FDA-approved to prevent recurrent C. difficile in certain populations,” said Johnson-Arbor. “Fecal transplants may also be beneficial for the prevention or treatment of other diseases that are affected by alterations in the gut microbiome, including inflammatory bowel disease and obesity, but there is currently insufficient evidence to support the use of fecal transplants for these conditions.”

Johnson-Arbor says it’s important not only to opt for commercially available fecal transplant pills versus DIY methods but also to be mindful of the potential side effects.

“Fecal transplants are generally well tolerated but are associated with gastrointestinal side effects including abdominal pain, diarrhea and constipation, and vomiting,” she explained. “In some cases, fevers may also occur after use of fecal transplant regiments.”