|NEWS AND VIEWS
|Year : 2013 | Volume
| Issue : 2 | Page : 166
The enema of your enemy is your friend
Department of Pharmacology, Indira Gandhi Medical College and Research Institute, Kadhirkamam, Puducherry, India
|Date of Web Publication||20-Apr-2013|
Department of Pharmacology, Indira Gandhi Medical College and Research Institute, Kadhirkamam, Puducherry
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sivagnanam G. The enema of your enemy is your friend. J Pharmacol Pharmacother 2013;4:166
| News|| |
Fecal transplants could be a cheap and effective treatment for gastrointestinal (GI) disorders. 
| (Re)Views|| |
Intestinal flora, called as microbiota, when disturbed has been associated with many GI and non-GI diseases,  such diseases include, Clostridium difficile infection (CDI), inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), chronic constipation and a host of others. Since the microbiome (the good bacteria that reside peacefully in the human body) plays an important role in cellular immunity and energy metabolism an imbalance in microbiota is also implicated to play a role in non-GI disorders such as autoimmune diseases, chronic fatigue syndrome, obesity, and some neuropsychiatric disorders. 
CDI often requires prolonged courses of oral vancomycin with attendant untoward effects apart from failure. An alternative therapy is administration of the entire fecal flora from a healthy individual termed as fecal microbiota transplant ([FMT]; also termed fecal bacteriotherapy or stool transplant), which restores the beneficial physiological microbiota with high (>90%) cure rates. , FMT is akin to a mega-probiotic, to repopulate a patient's intestines with beneficial microorganisms.
The procedure involves selecting and obtaining the feces from a close healthy family member (after administering a stool softener the previous night). Reason for selecting a close family member being, people living in close quarters are likely to have a similar set of gut bacteria, before anyone got ill. The sample is screened for presence of pathogens, such as hepatitis, salmonella, human immunodeficiency virus and parasites. Once cleared, the sample is mixed with saline to the consistency of an emulsion and filtered, and the filtrate is administered into the patient's colon through an endoscope (risk of bowel perforation), or into the stomach via a nasogastric tube (risk of aspiration pneumonia).
It is said that processing and infusing a glass of shit, costs negligible compared to spending about $3500 for a course of vancomycin.
To top it all it seems soon the patients will be educating themselves-Do-it-yourself mode-with a bottle of saline, an enema bag, and one kitchen blender, since sponsors are not forthcoming due to the nature of the natural, patent-free treatment, and bereft of a major profit.
Extension of the logic of fecal transplant to treat other intestinal conditions, such as ulcerative colitis, IBD, IBS, and chronic constipation seem to be promising. 
If only FMT happens to be encouraging in managing obesity, then the cost of lean man's shit would hit the roof.
| References|| |
|1.||Available from: http://www.slate.com/articles/health and science/medical examiner/2011/01/the enema of your enemy is your friend.html. [Last accessed 2013 Feb 18]. |
|2.||Brandt LJ. American Journal of Gastroenterology Lecture: Intestinal microbiota and the role of Fecal Microbiota Transplant (FMT) in treatment of C. difficile Infection. Am J Gastroenterol 2013;108:177-85. |
|3.||Aroniadis OC, Brandt LJ. Fecal microbiota transplantation: Past, present and future. Curr Opin Gastroenterol 2013;29:79-84. |
|4.||Kelly CR, de Leon L, Jasutkar N. Fecal microbiota transplantation for relapsing Clostridium difficile infection in 26 patients: Methodology and results. J Clin Gastroenterol 2012;46:145-9. |
|5.||Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infect Dis 2011;53:994-1002. |
|6.||Borody TJ, Warren EF, Leis SM, Surace R, Ashman O, Siarakas S. Bacteriotherapy using fecal flora: Toying with human motions. J Clin Gastroenterol 2004;38:475-83. |