LETTER TO THE EDITOR
Ulcerative colitis, Crohn's disease and irritable
bowel syndrome patients need fecal transplant
research and treatment
Dr. Barry Marshall, the Nobel Prize winning Australian
physician, showed that the Helicobacter pylori bacterium was
causing most peptic ulcers, reversing decades of medical
doctrine. A thorough review of the literature suggests that
inflammatory bowel disease (IBD; ulcerative colitis and
Crohn's disease) is related to bacterial dysbiosis (infection via
microorganism, injury, and or imbalance), the cause of
which may be multifactorial. If not, then why are antibiotics
sometimes used to treat IBD? Spouses of Crohn's disease
patients are at an increased risk for the disease.
can cause ulcers in the stomach, s o why would they, and
possibly viruses, not be capable of doing so further down the
gastrointestinal tract? I t is completely plausible. The
immune system has to react t o “something.”
Another Australian physician, Dr. TJ Borody, suggested
over a decade ago that dysbiosis, or microbial imbalances,
in the intestines may be a major contributing factor to
He demonstrated that fecal transplants
worked in six cases of ulcerative colitis unresponsive to
other treatments. They used enemas to replenish colons
with bacteria from the gut of a healthy fecal donor. The
researchers wrote, “Complete reversal of symptoms was
achieved in all p atients by 4 months…by which time all
other ulcerative colitis medications had been ceased.”
Follow-up articles by Borody indicated that while this
procedure may have to be repeated,
it does not involve
serious drug side-effects or surgical removal of the colon.
Perhaps, herein resides t he answer for ulcerative colitis,
Crohn's disease and even irritable bowel syndrome (IBS)?
The latest news is that fecal transplant has been used
successfully in both of the latter conditions. Despite Borody's
decade old hypothesis, IBD research and funding remained
focused on drugs to reduce symptoms, and not on the real
cause, and therefore real treatment, for IBD. When
researchers started to treat IBD with fecal transplant, the
FDA, quickly declared it a “drug” in need of an Investiga-
tional New Drug application, prior to further use (4/25/13
Letter). This was after ye ars of allowing it to be used for
Clostridium difficile. Blood or bone samples are not
considered drugs becau se they cannot be replicated, and
neither can fecal material. There are 500,000 to 3,000,000
annual cases of C. difficile, and 14,000 related deaths.
much objection, the FDA reversed its decision and no longer
requires doctors to get approval before using fecal trans-
plant, but only for C . difficile, and not IBD (6/17/13 Letter).
It appears that someone already knows that fecal transfer is a
promising treatment. A breakthrough, other than medical, is
needed to help millions of suffering patients, some of whom
Conflict of interest statement
I, Amy C. Brown, have no conflict of interest with regard to
this Letter to the Editor.
1. Carbonnel F, Jantchou P, Monnet E, Cosnes J. Environmental risk
factors in Crohn's disease and ulcerative colitis: an update.
Gastroenterol Clin Biol 2009;33(Suppl 3).
2. Borody TJ, Paramsothy S, Agrawal G. Fecal microbiota trans-
plantation: indications, methods, evidence, and future direc-
tions. Curr Gastroenterol Rep 2013;15(8):337.
3. Borody TJ, Campbell J. Fecal microbiota transplantation: current
status and future directions. Expert Rev Gastroenterol Hepatol
4. Borody TJ, Warren EF, Leis S, Surace R, Ashman O. Treatment of
ulcerative colitis using fecal bacteriotherapy. J Clin Gastroenterol
5. McKinney M. FDA slaps regs on fecal transplants. Increased steps
for C. diff treatment draw mixed reactions from providers. Mod
Amy C. Brown
Department of Complementary & Alternative Medicine,
John A. Burns School of Medicine, University of Hawaii at
Manoa,651 Ilalo Street, MEB 223 ,
Honolulu, HI 96813, USA
E-mail address: firstname.lastname@example.org.
9 September 2013
1873-9946/$ - see front matter © 2013 Published by Elsevier B.V. on behalf of European Crohn's and Colitis Organisation.
Available online at www.sciencedirect.com
Journal of Crohn's and Colitis (2013) xx, xxx
CROHNS-00853; No of Pages 1
Please cite this article as: Brown AC, Ulcerative colitis, Crohn's disease and irritable bowel syndrome patients need fecal transplant research
and treatment, JCrohnsColitis(2013), http://dx.doi.org/10.1016/j.crohns.2013.09.011