Your cousin’s poo can now cure your chronic stomach problems

‘Shit’ is one of the world’s most useful expletives, an all-purpose cry of annoyance that even kids pick up. But despite its ubiquity (just check out the wiki devoted to the scatological humour of the famous composer Mozart), anyone would get queasy at the thought of it being used as a medical treatment.But for those who are going through hell with chronic gut ailments, it can be a lifesaver. Some years ago, Megha Nagpal couldn’t imagine having a big meal, going on long road trips or even keeping a 9-to-5 job. For 18 years, chronic ulcerative colitis had virtually crippled her, leading to blood in her stool and more than 20 washroom visits daily. Till a ‘poop transplant’ turned this 37-year-old teacher’s life around. Now she can’t stop talking about her recent Vietnam trip.“In Vietnam, I binged on street food and enjoyed ice cream. Before 2020, I could only eat rice boiled with salt and turmeric. Those days are over. I am living the life now,” says Nagpal, who is among 100 recipients of faecal microbiota transplant (FMT) conducted by Dr (Col) Avnish Seth, a gastroenterologist at Delhi’s Manipal Hospital. Dr Seth had done India’s first FMT in November 2014, a year after the US Food and Drug Administration (FDA) approved the use of faecal material as a drug following extensive clinical trials. 113232425FMT can be simply explained as the process of taking the poo of someone with a healthy gut and inserting it in someone with an unhealthy gut so that their bad bacteria is repopulated by the donor’s healthy one.While scientists have long known that the human gut is full of diverse microbiomes, it’s only now that they are realising its importance. It helps digestion, produces chemicals that regulate the body and protect us against harmful pathogens. There are many reasons for the gut ecosystem going out of whack such as overuse of antibiotics, steroids or a Clostridium difficile (C diff) infection.The decision to opt for it didn’t come easy for Nagpal. “After 18 years of no relief, FMT was the last option. I lost several months just convincing myself. The ‘yuck’ factor remained until I noticed a drastic change in my body right after the third session. My cousin was my donor. Today, I am completely off steroids and live a healthy life,” says Nagpal. The first three sessions were 15 days apart. Thereafter, Nagpal has been on a ‘maintenance dose’ every six months.Treating a range of diseasesDr Cyriac Abby Philips — a hepatologist at Kerala’s Rajagiri Hospital better known as The Liver Doc on social media — says FMT is being used at the hospital to treat severe alcohol-associated hepatitis (SAH) with great results. Those affected with SAH have very low chances of survival without a liver transplant. But the hospital found that patients lived longer and healthier after FMT. “Of the 35 SAH patients who went through FMT, incidences of brain function loss, infections and major hospitalisations were much lower when compared to 26 SAH patients who received standard care. In some patients, it also reduced alcohol cravings. FMT is a far cheaper alternative to a liver transplant which costs around Rs 35-Rs 40 lakh,” says Dr Philips.He also found that FMT has some benefits for an autistic six-year-old who slept better and made better eye contact. “My son John had constant gut issues and wouldn’t sleep well due to abdominal pain. He didn’t even make eye contact with family members,” says his mother, who came to know about FMT through the internet. Now six, John went through four FMT sessions that began in August 2021, with a 15-day gap between each session. “His gut health improved drastically, he sleeps better now, and there’s improved eye contact with familiar faces,” says the mother. John’s donor underwent a thorough screening for use of antibiotics and history of infections before going ahead with the transplant. ShowQuotesPune’s Deenanath Mangeshkar Hospital has conducted 50 FMT procedures in three years to treat a range of diseases. “We found good results for graft versus host diseases, SAH, C difficile infection and for those who have undergone bone marrow transplant,” says the hospital’s consultant gastroenterologist Dr Sachin Palnitkar.But is poop a panacea?FMT comes with its own share of challenges, though. For one, the central government, health ministry, FDA and Indian Council of Medical Research (ICMR) are yet to set guidelines or protocols around it. Since the procedure involves a donor’s stool, careful evaluation is most crucial. Dr Palnitkar says it’s not the first line of treatment, adding, “Donors are mostly family members, but we insist on avoiding close kin who live in the same environment as it may not offer diversity in the microbiome. Distant relatives are most often the donors.” Dr Philips says donor selection is the single most important criteria when it comes to stool transplant. They follow a strict protocol to screen donors which includes their medical history, physical examination, infectious diseases, parasitology, general health screening, gastrointestinal health and preliminary psychological assessment as well.Also, microbiomes are still uncharted territory, and more research is needed to understand how the tiny microorganisms can control their host. “Several studies are required before FMT is accepted as a standard of care in patients with ulcerative colitis. But it has provided a ray of hope to thousands headed for colectomy, or those suffering from serious medication side effects. FMT should be performed only as a part of approved clinical trials,” says Dr Seth.