MINNEAPOLIS — Dr. Johannes Aas was stumped.
The patient in his Duluth, Minn., clinic was not responding to antibiotics, and now the infection in his intestines threatened to kill him. Then Aas found a similar case written up in a 1950s Norwegian medical journal.
The cure? Replace all the bacteria in the patient’s gut with a tiny dose of someone else’s stool. The cure that Aas discovered that day worked almost instantly, but other doctors scoffed. They are not scoffing anymore.
With the proliferation of dangerous superbugs that are resistant to antibiotics, the unusual treatment is gaining respect from researchers across the country. That shift in thinking reflects a growing regard for the complex and largely unknown bacterial ecosystem inside the human body.
The “microbiome,” as it is known, is the focus of a $115 million federal research project to investigate the bond between humans and their bacteria.
Aas’ patient 10 years ago had a common intestinal infection caused by a bacterium called C. difficile. It sometimes takes hold when patients get a dose of antibiotics for some other reason. These can destroy the population of beneficial intestinal bacteria, or flora, that digest food and provide nutrients to the body.
Then the spores of C. difficile, which can lurk in the gut, flower and take over. Often, a different antibiotic will suppress the infection. But sometimes C. difficile just keeps coming back.
“I was so, so, so sick,” said Keri Primbs, 34, of California, who was treated for a C. difficile infection in Duluth in 2006. The infection lasted on and off for a year.
According to the U.S. Centers for Disease Control and Prevention, hospitalizations from C. difficile infections increased by 23 percent each year between 2000 and 2005. Death rates tripled between 1999 and 2004.
Aas and his colleagues at the St. Mary’s Duluth Clinic, like other doctors across the country, began seeing more and more patients who just couldn’t get rid of the infection. Aas, at least, had a solution.
“If the normal flora in the colon is destroyed, in my book, you replace it,” said Aas, a gastroenterologist who is now semi-retired. With what? With someone else’s flora.
The procedure is not as bad as it sounds. More important, by the time people need one, they’ll do anything to get rid of their infection. Janet Jolliffe, 49, of Pennsylvania is a case in point. She is one of about 60 patients who have found their way to Duluth for stool transplants. On a crisp fall day, she sat in the exam room with an opaque tube running through her nose, down her throat and into her stomach.
“We just need that little brown bag,” said Dr. Timothy Rubin, a gastroenterologist who works with Aas. He meant the stool sample from Jolliffe’s husband, which was being processed in the lab. It was mixed with water and filtered, leaving a dark brown liquid that contained billions of bacteria.
Rubin used a syringe to inject the liquid through the tube and into Jolliffe’s stomach. It took less than a minute.
Aas says he doesn’t know exactly why the stool transplant works. But it works 95 percent of the time.
