Taking the Scientific Approach to Fecal Transplants for IBD

David Rubin, MD, Professor of Medicine; Interim Section Chief, Gastroenterology, Hepatology and Nutrition; Co-Director, Inflammatory Bowel Disease Center (Photo by Joel Wintermantle)

David Rubin, MD, Professor of Medicine; Interim Section Chief, Gastroenterology, Hepatology and Nutrition; Co-Director, Inflammatory Bowel Disease Center (Photo by Joel Wintermantle)

The success stories of using fecal transplants—that is, taking stool and the bacteria that comes with it from a healthy person and transplanting it to someone else—to treat recurring Clostridium difficult (C.diff) infections has sparked considerable interest in using the procedure to treat other gastrointestinal conditions such as Crohn’s and ulcertative colitis.

But David Rubin, MD, co-director of the Inflammatory Bowel Disease Center at the University of Chicago Medicine says just because a treatment seems “natural” doesn’t mean it will work for other conditions—or is even safe.

“We have no clue what we’re doing by filling people’s sick colons with the bacteria from someone else,” he said. “Just because it comes from another colon doesn’t mean in any regard that it’s necessarily safe for the recipient.”

In the normal bowel, more than 1,000 different strains of bacteria co-exist peacefully. Sometimes though, especially after the use of antibiotics, this delicate balance gets out of whack, allowing aggressive strains like C. diff to take over, leading to severe diarrhea, abdominal pain and intestinal damage.

A fecal microbiota transplant (FMT) is believed to treat this “dysbiosis,” or bacterial imbalance, by replacing the damaged bacterial population with one from a healthy person, like clearing away a house damaged in a storm and building a new one in its place.

Patients with inflammatory bowel diseases (IBD), including Crohn’s and ulcerative colitis, can also suffer from dysbiosis, leading some to think that FMT might relieve their symptoms too. But despite the enthusiasm, there is very little scientific evidence so far that this is effective, or even safe, for patients with IBD.

“We need to be careful. It doesn’t mean you can’t be enthusiastic. But we need to be thoughtful, and can’t abandon our principles when it comes to thinking about scientific advances.”

Rubin, who is also the interim section chief of gastroenterology, hepatology and nutrition, said there have been a handful of case reports published that show some success, but nothing on the level of a large, controlled clinical trial. In fact, in a recent study of FMT in five patients with ulcerative colitis (PDF) by a group of researchers from Austria, none of the patients achieved clinical remission, and only one showed some improvement. Several actually got worse.

In an editorial accompanying the study (PDF) in the American Journal of Gastroenterology, Rubin summarized the Austrian findings: “Unfortunately, we are learning that FMT for IBD is not the panacea many hoped it would be.”

He’s concerned that despite the lack of clinical evidence, some providers and patients will continue to experiment with FMT on their own because the “materials” are free and readily available at home. There’s even a burgeoning community online giving people instructions on how to administer FMT themselves.

Rubin and Stacy Kahn, MD, who Science Life spoke to last year about changing attitudes toward FMT, are conducting a phase 1 clinical trial of FMT in patients with mild to moderate ulcerative colitis to assess the basic safety of the therapy, just as they would with any other drug. Rubin said that if it looks like it’s working, they’ll consider expanding the protocol to sicker patients. But he stressed that it’s just the first step in a careful, scientific process.

“We need to be careful,” he said. “It doesn’t mean you can’t be enthusiastic. But we need to be thoughtful, and can’t abandon our principles when it comes to thinking about scientific advances.”

Rubin D.T. (2013). Editorial: Curbing our Enthusiasm for Fecal Transplantation in Ulcerative Colitis, The American Journal of Gastroenterology, 108 (10) 1631-1633. DOI:

Angelberger S., Reinisch W., Makristathis A., Lichtenberger C., Dejaco C., Papay P., Novacek G., Trauner M., Loy A. & Berry D. & (2013). Temporal Bacterial Community Dynamics Vary Among Ulcerative Colitis Patients After Fecal Microbiota Transplantation, The American Journal of Gastroenterology, 108 (10) 1620-1630. DOI:

About Matt Wood (443 Articles)
Matt Wood is a senior science writer for the University of Chicago Medicine and editor of the Science Life blog.

17 Comments on Taking the Scientific Approach to Fecal Transplants for IBD

  1. I was disappointed that this only referred to the studies that were not successful, and didn’t specifically refer to the ones that were. for instance, 7 out of 9 crohn’s patients recently achieved remission without drugs with a fecal transplant, it was not a case study. also in 2003, 6 patients with ulcerative colitis achieved drug free remissions and still remained in remission for up to 13 years post FMT.

    Also, we DO know something about how this works, it is not true that we “dont know anything” about what we are doing. we know quite a bit, but not enough yet, we dont know everything yet.

    here is some more info- http://www.crohnsforum.com/showthread.php?t=52400

    • Right, and I think Dr. Rubin’s main point–and maybe I didn’t write it clearly enough–was that there have been both successes and failures. The results for using FMT for patients with IBD have been mixed so far, and he’s encouraging everyone to take things a little more slowly to get a better understanding.

  2. Yes it’s disappointing that other more promising studies were not referenced including the one published in the US journal of Pediatric Gastroenterology & Nutrition last year.

    The bottom line is that unfortunately very sick people don’t have the luxury of sitting in the sidelines waiting for more research to be done. They live between a rock and a hard place. When faced with the prospect of downing increasingly more dangerous cocktails of drugs, losing their colons, their families or their livelihood, many see the potential risks of FMT as worth taking. Most are reassured by the fact that FMT has been used for many years to treat C diff without incident.

    As a member of an online FMT community I can assure you that many patients are seeing worthwhile results treating IBD with a combination of FMT and diet. A handful of those results are quite spectacular, with GIs being stunned at next colonoscopy. Yes, we all want more research. But who’s going to fund it? And what are desperately ill people meant to do in the meantime?

  3. There are many patients who try treatments that are not studied enough because they are desperate. We don’t shame them if it is a known potentially lethal drug, but we do when it’s something like fecal transplant, which , by the way, is simply by its nature not a drug. Yes, we need to be careful, but we also need to weigh the potential risks and benefits of other treatments that have known serious side effects. See the black box warning on Remicade, for example. I am sure that FMT saved my daughter’s colon when drugs did not. I don’t know for how long it will work, but the medications for IBD often don’t work forever, either. Those of us with chronic illnesses or beloved family members with chronic illnesses are always taking a leap of faith when trying a new treatment option. It would be objective journalism if you all cited the several studies (see Borody 2003, for example) that have shown FMT to be effective in treating IBD. That’s just not cool.

  4. Barbara Corley // January 29, 2014 at 4:20 pm //

    This interview does a great disservice to the many suffering from GI issues. First, fecal microbial transplant (FMT) is not some “new” science; veterinarians have been performing this for 100 years or more. Anyone who would caution the public from the “unknown” outcomes and give the opinion that one who enthusiastically supports this therapy might be abandoning their scientific principles needs to back up such opinion with facts. The article fails to do so. In fact, Clostridium difficile is a serious and growing problem. The implication that FMT is readily available to those suffering from is is not true. Last year, the FDA’s Biologic Division effectively shut down the ability to receive this treatment after a meeting in May. The move sent a chill throughout the medical community. My daughter was battling her third bout of Clostridium difficile within the past year and had been scheduled for FMT which was cancelled after the meeting. When Clostridium difficile reoccurred in August she was finally able to receive FMT at Johns Hopkins University Hospital. Within hours the symptoms had abated and she has remained asymptomatic. I question the ethics of a regulatory agency that oversees the drugs which have been created to treat chronically ill patients who suffer from IBD by taking steps to stop a therapy which has the potential to save lives and relieve the suffering of many. Can we really afford to wait while a “drug” is created to mimic the effects of FMT, which can then be monetized by the pharmaceutical industry? Scientific advances come from those willing to take risks. Let’s start discussing how we can fund such studies for the good of all, not just an industry, or an investor class.

  5. The article would have been more balanced if the author had considered other studies, such as those described at the at the American College of Gastroenterology (ACG) 2013 Annual Scientific Meeting. A swath of studies presented at this meeting demonstrated the possible spectrum of indications for fecal microbiota transplantation (FMT). See ‘ACG Abuzz With FMT’ – http://www.gastroendonews.com/ViewArticle.aspx?d=In%2Bthe%2BNews&d_id=187&i=January+2014&i_id=1026&a_id=24741

  6. FMT is the only thing that gave me relief from recurrent serious c diff infections and colitis. I just got put of a 9 day hospital stay for another recurrent infection and plan to do another FMT. I feel it’s very safe. I am a pharmacist but for me, poop is better than drugs!

  7. David Rubin, MD // January 30, 2014 at 11:02 am //

    Hi Everyone,
    I appreciate the passionate comments and the offers of other examples of FMT success stories. I also understand the skepticism many people have about the pharmaceutical industry, and what are viewed as my conflicts of interest raised in the comments above. I am replying publically because the assumptions and interpretations are not accurate. Please read on.
    The article was written about an editorial I wrote that accompanied a series published in the American Journal of Gastroenterology last year. I encourage you to read the entire editorial as well as the article on which it was based. You will see that I have not taken a position that FMT is unworthy of pursuit, nor have I ignored other positive anecdotes and selected series. I have in fact proposed that in this particular study the authors may have included the “wrong” patients, or that there are many reasons FMT did not succeed.
    I maintain that caution is warranted because it is absolutely true that we don’t fully know what is transplanted from one person to another in stool. As many of you many know, the FDA has taken the position that because fecal material is a biologic material, it requires their oversight and regulation. However you wish to interpret that decision, the fact remains that other proteins, antibodies and more than bacteria are being transferred from one person to another in these procedures. Protection of sick and vulnerable human beings (“desperate” is the term used above by one of you and by many people I see every week in my IBD clinics) is an essential part of medical care, the patient-doctor relationship, and certainly in any clinical trials or therapeutic innovations.
    In fact, we actively perform FMT here for recurrent C. difficile infection. And, more relevant, I have obtained investigational new drug approval (IND) from the FDA to study FMT in ulcerative colitis. Obtaining this permission took me and my colleagues 2 years and was funded internally at the University of Chicago and by grateful patients. Pharma has never been involved in any element of what we are doing. Our study (which is actively recruiting) is for milder ulcerative colitis and for patients who are not as sick as those who have failed FMT in other published reports. This is because I think this is the group most likely to benefit from this treatment approach. And, importantly, the study includes the scientific components that may allow us to understand why this works (or doesn’t) and how to improve it for the future. One might equally argue that if I am biased, it is in favor of FMT for UC given the resources we have invested. I want to see it succeed! But it can’t if we don’t identify the right patient groups to treat and study it as we do.
    As for the comments that this is propaganda or that it is somehow influenced by my consultation with industry, it is simply untrue. I have no financial stake in our FMT trial, and I have never discussed this study or our other non-pharma investigations with industry. The point that conflicts of interest should be mentioned is certainly well taken, and is the usual practice for any presentations or publications in which the products will be discussed or recommendations provided. But my comments in an editorial about caution and a scientific approach to FMT were never colored by any recommendation or even suggestion that we should be using one or any other therapy commercially available or otherwise instead. We actually have multiple other trials of diet, the microbiome and even surgical approaches, none of which have anything to do with the pharmaceutical industry.
    My interest in developing novel therapies for the many people living with IBD crosses many borders. I will do whatever we need to do to improve the quality of life of our patients. This includes consulting with industry so that they understand the diseases and develop better therapies, educating my colleagues (through CME), patients, and the on-line community about what is available and how we can use our current options more effectively (and safely), and in fact, studying and offering novel treatments that are not supported or in development by pharma.
    Thank you all for your interest and passion. I encourage you to continue in your readings and in your skepticism, but hope that my reply sheds some additional light on this. It’s easy to target a physician with a public profile who isn’t embracing an exciting concept as readily as you or others want. But I encourage you to be fair in your criticisms and hope you now know that my goal for all of the people who live and who suffer with IBD is the same as I presume yours is- a better quality of life and ultimately, a cure (or more accurately cureS) for these often terrible conditions.
    David Rubin, MD
    Jan 30 2014

    • Barbara Corley // January 30, 2014 at 11:42 am //

      I respect your position. Your passion is evident. I tried to read the article that the interview is based, but was unable to see it without subscription. My problem was with the tone of the editorial which the author recognized previously, and the perception that FMT is, or should be perceived as a riskier alternative to conventional medicine. I have already had to face accepting a part mouse/part human protocol, so the idea of transplanting one healthy person’s bowel movement doesn’t pose a monumental hurdle mentally to me. I am bothered by an agency of the govt. unilaterally deciding that the research being done with this material is inherently dangerous and therefore requiring stricter regulation because it is a “living organism.” It is problematic given that they single out this therapy and don’t also place the same restrictions on other “living organisms” such as probiotics, cheese, yogurts, etc. and I expressed my opinions directly to the agency. I do think there could be a conflict of interest present, considering the same arm of the agency is funded by the very companies that make the biologics which are the current protocol for IBD patients and I would be remiss not to express my misgivings.
      I feel that we have a problem in this country funding the development of new therapies. In that, you have a friend and supporter in me. I am passionate about the quality of life my child can expect living with a disease (Crohn’s) in which the therapies are all so risky (biologics, drugs developed to treat cancers, surgeries, etc.). Further, I believe IBD to be a complex problem in which current conventional therapies want only to look at turning off the immune response. I see that as narrow and possibly dangerous for some sufferers. FMT represents a novel approach to treatment which may help some, if not all, sufferers. That you are working toward this goal makes you my ally, not my enemy and I applaud you.

    • Thank you Dr. Rubin for responding to our concerns.

      it was this statement, which ill quote directly, that had me concerned.

      “We have no clue what we’re doing by filling people’s sick colons with the bacteria from someone else,” he said. “Just because it comes from another colon doesn’t mean in any regard that it’s necessarily safe for the recipient.”

      I interpreted this to mean you were implying or explicitly stating, we(as in the entire medical/scientific community) do not know anything, anything as in, nothing about this procedure. I Interpreted it to perhaps discourage interest in Fecal Transplant and its potential in IBD, and i believe it must be Promoted and encouraged, especially since we are coming out of the theoretical stages, and have some hard facts now.

      if we were entirely in the theoretical stages of the research, i may not have said anything about how this was worded. But human experiments have already been documented to give us some real data on safety, specifically in C. difficile, which we cannot entirely assume this data transfers to safety or efficacy in IBD , but does suggest it. But i will agree that studies for safety and efficacy in crohns disease have only recently been reported in late 2011, and the instances to date are few. but they do exist and must be acknowledged.

      Of course i am a patient with IBD, so im going to be a little more demanding then the usual reader, i just want to make sure these studies For Fecal Microbiota Transplants in IBD to go forward. If we were to talk about the theoretical underpinnings of why this might work, there’s plenty of data on that. But i’m so glad we have real human examples that prove its potential now, and many studies occuring in 2014 in humans.

    • Dr. Rubin,
      Thank you for the thoughtful explanation of your position. This full explanation was not apparent in the original article. Interestingly, those of us familiar with DIY FMT have found strong themes amongst this DIY community, some of which are alluded to in your response. For example, FMT seems to work best when inflammation is under control (wellbutrin/bupropion is useful in this). This does mean that there seems to be a “patient type”, where FMT is more likely to be successful, as you have pointed out. In addition, there seems to be a need to do a lot of consecutive FMT’s at the beginning (e.g. every day for 10 to 30 days) followed by tapering to fewer FMT’s, that are continued for a number of weeks or months. There is a study by Dr. Brandt that confirms the necessity for many FMT’s over a period of time for IBD. There is also a diet component, and following specific dietary protocols seems to enhance success of FMT’s.

      Thank you for carrying out studies on FMT. They are sorely needed, and your efforts are greatly appreciated. It must be exceptionally time consuming to complete the required IND application process, and you are applauded for carrying out the study, especially given the lack of formal funding.

      Incidentally, your editorial in the October 2013 issue of The American Journal of Gastroenterology is behind a paywall that the average reader will not access. Your points about the Austrian study perhaps using the ‘wrong’ patient are not part of the readily available text of the editorial, although your emphasis on the pressing need for more studies of FMT to determine why it works could be read.

      Although the long term consequences of stool transplants are unknown, there are also long term consequences of drug therapies which are unknown, or at least unacknowledged or undisclosed. Many members of the DIY FMT community can trace their health issues to overuse of antibiotics, antibiotics prescribed by doctors. The potential consequences of the antibiotics, ravaged microbiomes, was not disclosed to the patients. The long term consequences of antibiotic overuse are still not disclosed to patients, and there are members of the DIY FMT community with doctors that are adamant that the microbiome grows back within 6 months of discontinuing the antibiotic. Sadly, there are too many people with health issues that are a direct result of overuse of antibiotics who belie that assertion. This means that the long term consequences of some drug therapies are either not known or not acknowledged.

      Again, thank you for clarifying your position and for carrying out the FMT studies. I look forward to reading your published findings!

  8. Two and a half years ago I used fecal transplants along with prescription drugs to treat myself for Ulcerative Colitis after all other treatment options had failed and my GI had referred me for surgery. In my case I was not looking for a “natural” solution, I just wanted something that worked and after 12 years of illness my doctors didn’t have any other options to give me. It was the discovery of Dr. Borody’s article 3 days before I was scheduled to have surgery which prompted me to give fecal transplants a shot. Since then I have shared my experience with doctors whenever I can and also on discussion forums and through my website.

    I think your point that caution should be exercised and that this is not a panacea is definitely prudent. Based on my own experience I don’t think fecal transplants by themselves are the solution, drugs and nutrition played a part too, however I do believe they are an essential part of the solution. In addition to certain infectious diseases known to be spread through stool or blood which a donor would be tested for it is true that we also don’t know how the new bacteria will impact the person’s body, it can impact their metabolism and there is the possibility that some autoimmune diseases and other illnesses might be influenced by gut bacteria too. Most of the people I have talked to have severe illness for which almost all other treatment options have failed, and are very well informed. However I have seen some people who did not appear to be as well-informed who were looking for a panacea for conditions that did not involve infectious colitis or IBD. Certainly that latter group of patients could be a cause for concern.

    I think we should also be cautious about drawing conclusions from small sample sizes and when other variables are not being controlled for. For example what about the patient’s blood work for red blood cells and albumin? How about the extent of the inflammation and what medications, if any the people were taking? Also perhaps most importantly for how long did they continue with the fecal transplants? Based on the patient stories I have read where we have been successful, they have been done for a much longer period of time than 5 days. Also what ever happened to the 6 patients in Dr. Borody’s patients from the article published in 2003 “Treatment of ulcerative colitis using fecal bacteriotherapy.” (TJ Borody, EF Warren, S Leis, R Surace, O Ashman. J Clin Gastroenterol 2003; 37(1): 42-7.) Clearly this has worked in at least some cases of IBD documented by medical doctor and it also has by an increasing number of patients who have had at least some degree of contact with or guidance from medical doctors.

    In addition to drawing conclusions from small sample sizes, the risks need to be weighed against the rewards. For example the father of a friend of mine died last year from complications stemming from c. diff bacteria even after she told him about fecal transplants. The doctor refused to do them and her father stubbornly did not want to go to another doctor.

    In my case I was facing life-altering surgery after 12 years of Ulcerative Colitis which had proven to be treatment resistant. Treatments that failed included many drugs including Remicade which never brought about a sustained remission for me however contributed to a severe leg infection which prevented me from being able to walk for a few days and sent me to the hospital for 4 days.

    A few months after this incident I was referred for surgery a Total proctocolectomy with temporary diverting ileostomy and restorative Ileal Pouch-Anal Anastomosis, to be performed laporascopically at Mayo Clinic near Jacksonville, FL. This was near my parents house in Gainesville, since I was told I would need help caring for myself after the operation.

    Two months before my surgery date, the colo-rectal surgeon told me that my blood albumin levels were low, this is I did not have enough protein available in my body for optimal tissue healing post surgery. I was also to taper myself off Prednisone. Interestingly enough as I consumed lots of whey protein shakes I finished tapering off Prednisone a month before my surgery date and regained 20 lbs of body weight I had lost in the previous months. This made me question surgery once again, however I was assured by my doctors that it would only get worse again and was incurable.

    Then just 3 days before I was scheduled to have surgery I read Dr. Borody’s article in the Journal of Gastroenterology. After staying up all night to read about fecal transplants and bacteria and also the reported risks of surgery, I decided to cancel surgery and called Dr. Borody’s office and others and spoke to a doctor in the U.S. who has been a pioneer for the use of fecal transplants. The doctor put me in touch with a woman who had used fecal transplants to successfully treat her son while keeping in touch with Dr. Borody. This woman assured me that based on her son’s experience and what she had learned from doctors that 5 days of fecal transplants was not going to be enough, especially for a severe case and that I should plan on possibly several months to make sure this became permanent. So I changed my plans and ended up finding a healthy donor around Washington, DC who was healthy and decided to mix and administer my own enemas at home using procedures published in medical journals. My plan was to keep going indefinitely for up to a few months until I could beat the illness.

    Almost immediately I noticed some noticeable improvements. However within a few days I ran out of Apriso and then gradually symptoms started to come back as I continued to do the enemas on a daily basis. Then I went back on Prednisone and called my old doctor to see if I could get some new prescriptions while continuing the fecal transplants. Finally when the doctor who had referred me for surgery got back, he was surprised to see me and insisted that I stop the fecal transplants for the time being after I had done 5 weeks of daily enemas. I noticed that even after the enemas had stopped the color and smell of my stool now continued to match that of my donor.

    A few days later I got a prescription for Bupropion from the psychiatrist who had treated me for many years for ADHD and seasonal depression. I asked for the prescription after reading of some laboratory studies showing the drug could be effective as a TNF-a inhibitor in mice, a case study published in the journal of Gastroenterology about Bupropion’s used in Crohn’s Disease, a few patient stories on the internet and the existence of a clinical trial by GlaxoSmithKline “A Trial of Wellbutrin for Crohn’s Disease” for which study results were never published. My doctor also prescribed Silenor (6 mg Doxepin) to help for sleep problems related to Prednisone. He also said it would help for IBS symptoms as well.

    Within a day after starting Bupropion 300 mg immediate release, re-starting Apriso and mesalamine suppositories while continuing at 40 mg of Prednisone I had a very sudden remission of symptoms, I went from watery diarrhea with a little blood one day to a soft formed stool without any blood the next. I started to rapidly improve and tapered off of Prednisone within the next two weeks. About 8 weeks later I had a colonoscopy which revealed significant mucosal healing which some patches better than others. I continued to take mesalamine for another 3 months then finished in December 2011.

    Since then I have started a website to share my experience and answer questions by others who would consider using fecal transplants http://www.FecalTransplant.org

    I have now been in sustained remission without any medications that are prescribed for Ulcerative Colitis since 2011. During that time I have not strictly limited wheat or dairy, however I still limit some high fiber fruit, nuts and vegetables. I have also continued to take Bupropion off and on and went back on it as winter approaches then year when I started to have some more frequent diarrhea which stopped within a day or two after going back on it.

    If you want success in clinical studies using fecal transplant for IBD, I would recommend including elements in the trials that have worked for people like myself that have had success with this. I think in my case the key to my success was that I simultaneously addressed all elements of the feedback loop of inflammation, nutritional deficiencies and bacterial composition. To the best of my knowledge these factors have not yet been considered in any of the studies that I have seen which are attempting to test the effectiveness of fecal transplants alone to treat the illness.

    I think success rates would be much higher if patients get abundant large amounts of protein to speed healing of the mucosa and also actively use drugs to control inflammation during the fecal transplants and for at least several months after symptoms have been mostly absent. Also using drugs to treat Irritable Bowel Syndrome (IBS) symptoms should also be considered for their ability to help retain enemas and limit muscle spasms and diarrhea which could also aid healing. Some anti-anxiety and anti-depressant drugs are sometimes prescribed for IBS and clearly there is a link between change of seasons and emotional stress in triggering a flare, so this does not seem to be too much of a stretch either.

    I also think for the fecal transplants themselves the trials should consider extending the period of time during which the fecal transplants are used to a few weeks daily and then gradually taper them down over time depending on the amount of diarrhea the patients still have. Also consider including periodic booster enemas or capsules over the following months up to a year especially if patients have any diarrhea or are prescribed antibiotics for another condition. I think you are right doctor that fecal transplants are not a panacea, but I do think they can be an effective part of a sustainable treatment option for a great deal of patients and I applaud your efforts to help us find ways to resolve this illness.

  9. Denise Hartling // January 30, 2014 at 8:03 pm //

    Dr. Rubin,

    I felt compelled to echo the comments by “DT” regarding the unknown, unacknowledged and/or undisclosed consequences of drug therapies. I am the victim of long term antibiotic overuse for UTI’s mostly. However I seemed to do ok until they gave me Cipro which led to more Cipro which then led to Cephalex and then a z-pack (all within a 9 month period) because of some bizarre symptoms caused by the Cipro. No one goes from perfectly healthy to chronically ill almost overnight and that is exactly what happened to me. And I was told by numerous doctors that the micro biome grows back within three to six months after discontinuing the antibiotics. This simply is not true. I am shocked and saddened that the medical community refuses to do more research in this area and recognize that there are many other gut issues that are the result of antibiotics.

    I never had gut problems in my entire life. I am 56 years old now so I went 54 years with no gut problems ever. Not a coincidence. There is a reason I have gut problems now. My micro biome has been decimated by antibiotics.

  10. Dear Dr. Rubin,

    First, I appreciate you taking the time to respond to the comments in this thread. I certainly agree that we have a long way to go before we know the safety and effectiveness of fecal transplant. I appreciate the interest on the part of the FDA to look carefully at the use of it. I do hope you understand, though, that many of us who have used fecal transplant have done so after much research and consulting with medical professionals. There are many of us, too, who have seen initial dramatic results from fecal transplant and then saw a return of some symptoms. I, for one, know that fecal transplant is not a cure for some cases of UC, but I do know that it worked for my daughter for 10 months. We are now working closely with a nutritionist who has been working with IBD patients for over 30 years (we began after she started showing some symptoms again). I have traveled to different states and consulted with a doctor overseas in order to help my daughter. I have read countless research articles. I am not a physician, but I can tell you that we have taught our physicians and they have taught us. Our decisions on treatments have been shared openly with our doctors, and we welcome any and all input and recommendations they share. We have done things out of our comfort zone, as have they. That is the kind if team everyone deserves to be a part of. IBD is more complicated than any of us know, and I am confident that the diseases will require a multi-pronged approach to manage them well–so that patients do have the best quality of life they can hope for. I hope in the future to see some research that combines both microbiome therapy, nutritional therapy and pharmaceutical therapy in such a way that manages IBD with as few scary side effects as possible. Healing the gut and fixing the microbiome may be two key factors in getting people well. I would be more than happy at any time to share with you what we are doing to get and keep our daughter well. I know we are all on the same team, and I do hope that medical professionals will take those of us who have a vested interest in seeing those we love healthy and who have worked really hard trying to find an effective treatment for those individuals, seriously, and appeal to us as the valuable assets we can be.

    Kathy Lammens, Ph.D.

  11. Dr Rubin, thank you for your thoughtful response and for the research you are doing on FMT & UC. It’s only by having frank and open debate on the issues, that we can both raise awareness of FMT, and engage the community in discussion on the importance of the microbiome to human health.

    Matt Wood, I hope you can appreciate that it’s important to seek the patient perspective before writing an article like this. As you can see from the quality of comment here, we are not birdbrains, weirdos or quacks. Just patients stuck between a rock and a hard place.

    Yet it does not seem to occur to journalists to approach patient groups for comment anymore than it occurred to the FDA last May to take 5 minutes to google “C diff support group” and invite patients to its FMT workshop. It’s the 21st century and this paternalistic attitude toward patients needs to stop. Patients are the pivot around which medicine turns. Our perspectives matter.

    • Hi Tracy,

      I’ve read through the article dozens of times over the past few days to make sure I didn’t give the impression that I think patients seeking FMT are “weirdos” or “quacks” because I was really conscientious about that from the beginning. My wife has type 1 diabetes and celiac disease, and I absolutely understand the pain and anxiety of living with an incurable chronic condition that has partial and often ineffective treatments. I would never make light of those frustrations.

      We have actually covered on this blog the story of a little boy who was treated here at the University of Chicago with FMT for a c.diff infection (https://sciencelife.uchospitals.edu/2013/01/02/fecal-transplant-helps-one-year-old-beat-relentless-infection/). I’ve also spoken to Dr. Kahn here about the ethical and social issues that come up with FMT (https://sciencelife.uchospitals.edu/2013/06/12/patients-are-over-the-yuck-factor-of-fecal-transplants/). I know that isn’t the same thing though, and I look forward to reporting on Dr. Rubin’s findings from the trial on UC.

      There are tons of different perspectives and opinions and disagreements about the subject, and I’m glad we’ve been able to expand the discussion in the comments here. But this was never meant to be a comprehensive story covering every aspect of such a complex topic in a 500-word blog post. Instead, it was meant to bring attention to Dr. Rubin’s editorial on the recent Austrian study, because it was originally published in an academic medical journal that the general public probably didn’t see. It’s just one addition to the larger conversation.

      On that note, I see that some folks haven’t been able to access the original articles, so here are some links to PDFs that you can download. I also added those links in the article for people who haven’t been following along in the comments:

      Austrian study: https://uchicagomed.files.wordpress.com/2014/01/ajg2013257a.pdf

      Dr. Rubin’s editorial: https://uchicagomed.files.wordpress.com/2014/01/ajg2013279a.pdf

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