Fecal Transplants Are a Success for Kids with Severe C. Diff

Fecal Transplants Are a Success for Kids with Severe C. Diff

Jeff Ballinger

Children with severe gastrointestinal infections caused by Clostridium difficile are being treated with fecal microbiota transplants at Columbia and seeing their symptoms disappear after multiple courses of conventional therapy with antibiotics failed to prevent recurrence.

“The procedure has been successful for every patient we treated,” says Joel Lavine, MD, PhD, professor and vice chair of pediatrics.

Since 2012, 14 children with recurrent C. difficile infections have been treated at Columbia with transplants, an infusion of a fecal preparation from a healthy donor into the gastrointestinal tract of a patient. “C. diff” infections are uncommon in children, but they have increased 10-fold over the past two decades and are becoming harder to treat. In certain cases, C. diff inflames the colon and causes severe abdominal pain and debilitating diarrhea.

The goal of a fecal transplant is to replace the patient’s harmful microbiota with bacteria that support a healthy gastrointestinal milieu. Donors are typically parents or siblings of the patient and they are screened to meet strict criteria, such as being free of autoimmune, neoplastic, infectious, and metabolic diseases.

“The families we have worked with describe the therapy as life-changing,” says Norelle Reilly, MD, director of the pediatric celiac disease program and assistant professor of pediatrics. “Many of the children we have treated have experienced years of refractory C. diff infection and endured numerous antibiotic treatments, limited contact with friends, and missed months of school. It is gratifying to be able to intervene in such a novel and meaningful way.”

In one of the first published case series of children treated with fecal transplants (in the Pediatric Infection Disease Journal), Dr. Reilly detailed Columbia’s first six cases out of the 14 total now performed, including one in a 21-month-old baby. No clear complications from the transplant occurred, although long-term outcomes remain to be assessed.

“Theoretically, it’s possible that a recipient may acquire the donor’s predisposition for conditions such as autoimmunity, psychiatric illness, and obesity,” she says. Despite these questions, the success of fecal transplants for C. diff is raising hope about the use of fecal transplant in other diseases.

“A variety of exciting studies are currently ongoing worldwide, exploring the procedure’s potential for irritable bowel syndrome, Crohn’s disease, ulcerative colitis, liver disease, and type 2 diabetes,” says Esi Lamouse-Smith, MD, PhD, assistant professor of pediatrics and a member of the Columbia Center for Translational Immunology. Investigators are also exploring different routes of delivery other than the colon, the use of frozen or fresh specimens, and the use of synthetic microbial suspensions rather than donated specimens. Dr. Lamouse-Smith’s own research examines how an infant’s gut microbiome determines how a person responds to vaccines, viral infections, and allergens.

Dr. Lavine says it should become clear over time how to refine the protocols to deliver the best results. This includes developing the most effective means for delivery and the optimal dose and timing for treatment.


More information is available by calling the Division of Pediatric Gastroenterology, Hepatology, and Nutrition at 212-305-5903.