I posted this in another FT thread, but I thought it was a good summary with links to relevant/interesting medical articles, and deserved its own thread.
I think the medical establishment will look at FT as well as other innovative therapies - it just takes more time than lay folks realize. Big pharmacy will not sink a lot of R&D into it, unless some aspect of the product can be patented, but big pharma has increasingly relied on university researchers to to the basic foundational work. ... and the National Institute of Health and other agencies will fund promising research even if it does not look commercial.
Recently there have been reviews of FT in gastro literature (see http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2011.04737.x/abstract for a review of 22 studies where 5 were not c-diff studies), and its striking success for c-diff colitis (fecal transplantation for C. difficile has been demonstrated to be effective in 87% of patients), almost ensures closer examination for regular (idiopathic) UC. FT is also mentioned in reviews of probiotics more generally. Very recent studies have looked to see how willing UC patients would be to accept this type of therapy despite the yuck factor (http://www.ncbi.nlm.nih.gov/pubmed/21618362).
There is also a lot of research into how exactly probiotics help, independent of whether it is rectal, oral, processed, or "wild type". So I think FT is getting attention, and I think given the mixed results, it is getting a fair share of attention considering all the other UC topics that are being researched. It makes sense that UC patients who seem to be out of options might consider this. Perhaps others with untried options might wait at this time because it is not clear what the risks might be or how to do FT most effectively.
The main argument in support seems to be that "wild type" biotics, which includes many many strains, could plausibly be better than manufactured/processed probiotics that only include a short list of strains.
The issue/caution is that the evidence for FT in treatign non c-diff UC is weak, and at best it appears to take multiple doses over extended time. All the other issues like how well the biota travel and/or colonize and what is the best mode of administration also have to be worked out.
The bulk of published support for FT in non-c-diff UC largely comes form 7 patients, although more have been treated - just not published. In 1989 a Dr. Bennett with UC who had first tried all options, reported placing himself into seeming ongoing/durable remission. Then in 2003, Dr. Thomas Brody of Australia, who 1st treated a non-c-diff UC patient in 1988 with FT, published six remarkable case studies spanning 1988 to 2002, where after 5 daily FT treatments, each patient went into seemingly ongoing/durable remission starting a few weeks to several months later. (A link to this article was posted in another FT thread just last week.) These six case reports are cited in several research reports and research reviews that have come out since 2003.
Although very encouraging, case studies are not fully-scientific, and are still anecdotal. Specifically he picked 6 cases that worked 100% to publish, and was under no obligation to report how many others were treated during those years with less success or even with no success - or even with adverse reactions. And we can tell from Brody's more recent writing, that some number of additional people had been treated, and that the success was not as dramatic.
Brody writes in his 2011 review, Fecal microbiota transplantation: current status and future directions (http://www.expert-reviews.com/doi/full/10.1586/egh.11.71):
Brody said...
It is our current clinical impression that, while C. difficile is easily eradicated with a single FMT infusion, this generally appears to not be the case in UC. From our initial publication in 2003 reporting on the treatment of six UC patients with five FMT infusions, our subsequent unpublished experience is that multiple and recurrent infusions are required to achieve prolonged remission or ‘cure’. This observation raises a number of key questions to be answered: which type of colitis will be most suitable for treatment? What should the frequency pattern and duration of infusions be? Are younger patients more likely to achieve healing or cure? What proportion will actually achieve cure? [emphasis mine]
Brody also says...
Adequately designed, randomized controlled trials of FMT in UC by clinics specializing in IBD are now needed to provide the answers
Post Edited (DBwithUC) : 2/2/2012 10:13:30 AM (GMT-7)