Nine out of ten patients with life-threatening diarrhoea can be cured by a faecal microbiota transplantation, which is where faeces from a heathy donor is inserted into the intestines of a patient. However, only one in ten are actually offered the treatment. This is shown by an overview which researchers from Aarhus University and Aarhus University Hospital have conducted. The researchers also found that Denmark is at the forefront of all European countries in introducing the treatment.

2021.08.29 | Helle Horskjær Hansen

FMT is an effective treatment for the life-threatening infection Clostridium difficile, and it is now being used in most countries in Europe and in USA and Australia. But although the treatment is effective, it is not offered everywhere.  

"There are major differences in how the treatment has been introduced and how much it is used in the different countries. The common element is a high level of safety and that most centres have introduced the treatment in consultation with the national health authorities," says Christian Lodberg Hvas, clinical associate professor at the Department of Clinical Medicine at Aarhus University and consultant at the Department of Hepatology and Gastroenterology at Aarhus University Hospital. 

Together with colleagues from all over Europe, he has looked into how many faeces transplantations are being carried out in different European countries and for which diseases. The study has been published in the scientific journal The Lancet Regional Health – Europe.

"We can see that ten per cent of those who could benefit are offered the treatment. The figure is significantly higher in Denmark but still only around twenty-five per cent. In relation to population, we’re the country in Europe that treats the most patients with Clostridium infection," the researcher says.

Nine out of ten recover

According to the researcher, there is good reason to continue the treatment. In Denmark, ninety per cent of patients are cured by one faeces transplantation.

"Faeces transplantation is recommended as the first choice in patients who experience that the bacteria returns after a course of antibiotics. In all countries where the treatment is used, the patients are monitored to see whether they suffer long-term consequences of getting a new set of intestinal bacteria," says the researcher, who has helped to build up the Danish faeces bank from healthy donors.

"If the Clostridium difficile infection isn’t remedied in the most poorly patients, they will die from it – when we agree on the treatment with patients we’re often having a life or death conversation. A single faeces transplantation is effective. “In a matter of days, very ill people can again get out of bed and are ready to return home to a normal life, of course with us on the sidelines," says Christian Lodberg Hvas.

Faeces transplantation is currently being introduced as routine treatment in the Danish hospital system. In the autumn of 2018, Christian Lodberg Hvas and his colleagues received a grant of DKK 17 million from the Innovation Fund Denmark. The money is earmarked for the task of turning faeces taken from healthy, registered and tested donors into standard treatment in Danish hospitals.

Clostridium and the faeces bank – more information

• The life-threatening disease Clostridium difficile is a kind of “weed” bacterium that can grow if there are no other bacteria to stop it. Clostridium grows e.g. in the intestine after a patient has received antibiotics that have degraded the natural intestinal bacteria.
• More than forty healthy faeces donors are affiliated with the Aarhus Faecal Bank. They have all been recruited via the blood bank, where they already donate blood.
• As a faeces donor, you must be of normal weight and free of medication, as there is a risk that overweight and allergies and similar can be transferred via intestinal bacteria.

The research results - more information 

• The study is based on a questionnaire survey covering all hospital-based centres for faeces transplantation in Europe. The centres are gathered in a European working group (European Helicobacter and Microbiota Study Group under United European Gastroenterology), and the survey has therefore made possible a complete mapping of the use of faeces transplantation. The researchers have collected data from 34 hospitals in 18 countries that all perform faeces transplantations.
• The study is financed by the Innovation Fund Denmark.
• The collaborative partners are the other centres plus UEG
  Read the scientific article here. In the same issue, the journal also published an editorial revealing the "hidden figures" of faeces transplantation. The editorial can be read here.

Contact 

Consultant, Clinical Associate Professor Christian Lodberg Hvas
Department of Clinical Medicine, Aarhus University and 
Department of Hepatology and Gastroenterology, Aarhus University Hospital
Mobile: (+45) 2835 1839
Email: christian.hvas@auh.rm.dk.