SKH headshotSuchi Hourigan, MD, is board certified in pediatric gastroenterology. She treats children of all ages and has a particular interest in the gut microbiome, nutrition and disorders of the intestines. She’s also the director of microbiome research at the Inova Translational Medicine Institute, where she studies the role of gut bacteria in human health and disease. Read Dr. Hourigan’s profile.

The first time I performed a fecal transplant, my patient was an 11-year-old girl. She had Crohn’s disease, which causes long-term inflammation of the gastrointestinal tract. She’d also suffered from a recurrent infection with a bacterium called Clostridium difficile for four years.

During that time, she was frequently hospitalized. She was on antibiotics almost constantly and often couldn’t eat.

About two years ago, we treated her with a fecal transplant. Since then, she’s been free of “C. diff,” as the disease is nicknamed. While she still has Crohn’s disease, it’s been much easier to keep it under control now that the infection has gone.

fecaltransplantsWhat Are Fecal Transplants?
Our bodies contain trillions of bacteria and other microscopic organisms. Collectively, the genetic contents of those organisms is known as our “microbiome.” We now know that these tiny stowaways play a vital role in our health. They help fight off harmful bacteria, aid in digestion and are involved in the development of the immune system.

But when the microbiome gets out of balance, it can contribute to diseases such as obesity, inflammatory bowel disease, asthma, autoimmune diseases and neurological conditions.

As a pediatric gastroenterologist, I’m particularly interested in understanding how to correct microbiome imbalances in children to prevent and treat disease. One strategy that’s growing in popularity: Fecal microbiota transplantation (FMT).

FMT involves transferring fecal matter — and the microorganisms it contains — from a healthy person to a patient with a microbiome imbalance. This can be done through a tube into the upper or lower gastrointestinal tract or, more recently, by swallowing freeze-dried capsules. Despite the “ick” factor, FMT can be extremely effective.

FMT is not a new idea. In fact, fecal transplants were used to treat diarrhea in the 4th century! But FMT has emerged as a modern therapy in the last few years, as research has proven its effectiveness. Its rise in popularity is partly due to the rapid rise of C. difficile infections.

C. difficile is the top cause of hospital-acquired diarrhea. In severe cases, it can even be life threatening. Unfortunately, it often comes back after antibiotic treatment, forcing patients to battle the infection again and again.

FMT has become an important tool for treating recurring infections of C. difficile and restoring balance to the gut microbiome.

Unanswered Questions: More Research Is Needed
FMT has proven to be an excellent treatment for C. difficile infections in adults. It also appears to be an effective way to treat recurrent infections of the disease in kids, as I recently described in an article in the journal Pediatric Research—and as I have seen firsthand in patients like the 11-year-old with Crohn’s disease.

Still, we need to do more research to understand the risks and benefits of using FMT in children. We need to make sure that altering children’s microbiomes doesn’t put them at risk of developing other health problems in the future.

To help answer those questions, I’m leading several studies of the microbiome at the Inova Translational Medicine Institute. One of those projects is examining the microbiomes of children before and after they receive FMT for recurrent C. difficile infections.

The Future of Fecal Transplants
Someday, FMT (or similar treatments made from lab-grown bacteria) could be used not only to fight infections but also to treat a range of other diseases linked to bacterial imbalances. I’m hopeful this research will help us better understand the human microbiome, how it develops and how it contributes to disease.

Visit Pediatric Specialists of Virginia Research and the Inova Translational Medicine Institute to learn more about participating in our studies of children’s microbiomes.

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