Turning to faecal transplants to treat symptoms of debilitating gastroparesis

0:00

Kerryn Barnett suffers from gastroparesis - a motility disorder that delays the stomach emptying into the small intestine - and is turning to an experimental faecal microbiota transplant (FMT) to help treat her severe symptoms.

Kerryn Barnett had no idea what a faecal microbiota transplant (FMT) was she was referred to a Sydney clinic for treatment. 

“My reaction was quite horrified. Just at the thought of what it was," she says. "But I was at a point where I had nothing to lose and everything to gain.”

Kerryn has gastroparesis, which means her stomach can stop or is sluggish in moving food on to the small intestine. In a healthy person, the muscular stomach grinds and mixes food together making it small enough to travel through to the small intestine. The movement that pushes food toward the small intestine is controlled by the vagus nerve.

A breakdown of that process can have devastating effects. In Kerryn’s case, her stomach was retaining 84 per cent of the food she was eating and her symptoms are severe.

“I had lost 15kg in five months, I was vomiting 14 to 16 episodes a day, basically surviving on Hydralite ice blocks,” she says.

Treatment options are limited and it can be difficult to manage the symptoms.

“I mainly have a kind of fluid diet and have small main meal during the night. I stick to foods that are easily digested,” she says. “It’s affected pretty much every part of my life, I’ve not got the ability to work full time, I used to enjoy playing soccer and going out running. It’s impacted on my children and my family life.”

A gastric pacemaker was inserted into Kerryn’s stomach in 2015 and it offered some respite. Electrical stimulations from the pacemaker help to move food through to the bowel. She managed to gain seven kilograms and most of the vomiting stopped.

But towards the end of 2016, Kerryn was hospitalised on four separate occasions for bowel obstructions. She was told that the pralysis causing problems in the stomach and small intestine had spread to her large intestine.

FMT became the final treatment option for Kerryn before facing the reality of having her large intestine removed.

A faecal transplant involves donor faeces being blended with saline and then delivered to a patient’s large intestine by colonoscopy, enema or tube inserted down through the nose.

Dr Sam Costello, a gastroenterologist from Queen Elizabeth Hospital in Adelaide, says the process is fairly crude. Appearing on an Insight exploring gut health, he says the aim is to replace the existing microbiome with a more normal ecosystem of bacteria.

Donor poo is screened for potential infections but the risks of transplanting faeces into someone else’s body are unknown.

“The faecal transplant has only really been performed in large numbers in the last say five to ten years at most so we don’t have long term data,” Dr Costello told Jenny Brockie on this week's Insight.

The use of FMT to treat recurrent clostridium difficile (C.diff), an inflammation of the colon is extremely effective. Dr Michael Mosley agrees, telling Jenny Brockie it is “as close to a medical miracle as you’re going to get”. 

There is emerging evidence that faecal transplants can induce remission for patients with ulcerative colitis and its’ potential to treat a range of other conditions is currently being explored.

“There are early stages of exploring it’s use in other things, including obesity, type 2 diabetes and strangely enough autism, but very early stage experiments,” says Dr Mosley. 

While FMT has not been proven to be a clinically effective treatment for gastroparesis and is experimental, Kerryn hoped it might offer some symptomatic relief. 

“By changing the gut flora and bacteria it will change the motility of the gut. Faeces get stuck because there is nothing to move it to through the colon,” says Kerryn.

“With gastroparesis, it’s relatively unheard of to use this type of treatment. So I guess, in a sense, it’s a bit experimental.”

With gastroparesis, it’s relatively unheard of to use this type of treatment. So I guess, in a sense, it’s a bit experimental.

Kerryn allowed Insight to observe the first day of the her treatment that she received at the Centre of Digestive Diseases in Sydney, which involved the first FMT delivered via colonoscopy and then a enema delivered daily for 10 days.

Although it has only been a week since finishing her treatment, the results are already showing for Kerryn.

“I’ve gone from only being able to open my bowels every 5-6 days with medications, sometimes up to 11-12 days requiring hospital admissions, to practically being regular each day without medication.”

Dr Suhirdan Vivekanandarajah, her treating doctor at the Centre for Digestive Diseases says it may take up to twelve months to see a benefit. Patients are encouraged to eat a high-fibre diet post treatment and avoid antibiotics if possible.

“It’s so exciting to be able to share positive results … I’ve also go so much more energy and have had so many people comment on the change of colour and the healthy look of my face,” says Kerryn.

For those that have found other treatments to be ineffective and are left with the option of having their large intestine removed, Kerryn hopes that this treatment could be the answer for other suffers.

“I’m so fortunate that this was offered and I took the risk.”

Kerryn, just before her FMT treatment
Kerryn, just before her FMT treatment
Insight
 

GASTROPARESIS

According to Western Sydney University, an estimated 125,000 Australians are living with gastroparesis. Clinicians find that with most patients diagnosed with gastroparesis they are unable to identify the cause of the disorder with medical tests.

Gastroparesis is also common in people with Type 1 Diabetes.

Symptoms of gastroparesis can include chronic nausea, a feeling of fullness after eating small amounts of food and vomiting.

Treatments for gastroparesis offer symptomatic relief and there is currently no cure for the condition. Some people that suffer from gastroparesis become dependent on gastric nasal tubes for nutrition or have a permanent tube inserted into their abdomen that enables the stomach to be drained and nutrients to reach the small intestine.

Source Insight