When dealing with Number 2, pills are Number 1

In news that might not seem all that surprising, Canadian researchers report that patients prefer ingesting faeces in pill form in preference to having it pushed into them through a tube.

The results of the trial, however, published in the Journal of the American Medical Association, could turn out to be extremely useful. Faecal transplant is recognised as an effective treatment for a stubborn and painful inflammatory condition known as ulcerative colitis, caused by a bacterium called Clostridium difficile.

Initial treatment for the condition involves one or two courses of antibiotics, but the bacteria are tough and often surge back after treatment finishes. 

By that stage, much of the patient’s intestinal microbiota – the population of microbes that enable digestion – has been destroyed. The best way to return to healthy levels is to transplant the microbiota of a donor – in the form of faeces in a saline solution.

A recent small study reported that 60% of children with ulcerative colitis who received a transplant experienced improved symptoms. 

Another 2017 study sounded a note of caution, damping down expectations that poo transplants, although yucky, do not have a downside. Research by scientists from the Universite de Sherbrooke in Canada found that in mice faecal transplants upped the risk of premature birth.

As treatments go, faecal transplants can be difficult to cope with, especially for children. The donor material is delivered either using a colonoscopy, an enema, or a nasal tube.

In the most recent research Dina Kao of the University of Alberta and colleagues conducted a randomised clinical trial to test whether faecal transplant pills were as effective as colonoscopy delivery in reducing the severity of ulcerative colitis.

The trial involved 116 volunteers and took place over two years. The results showed that 96% of patients who received either treatment were clear of C. difficile infection after 12 weeks.

If the effectiveness of the two strategies was broadly comparable, the patient experience was markedly different. The researchers reported that “significantly more people who got the pills rated their experience as ‘not at all unpleasant’.”

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