Horrible digestive illness caused by the bacterium Clostridium difficile (aka, C. diff) is on the rise.

The number of hospital stays caused by the bacterium have tripled over the past decade, according to the CDC—with watery diarrhea and terrible abdominal cramps that sometimes come back again and again even after powerful antibiotics are taken.

Sometimes C. diff infections become so overwhelming that doctors have to perform a colectomy—surgical removal of all or part of the colon—and in some cases, C. diff patients die.

But there is a treatment that has proven astonishingly effective, even though it’s rather icky to think about.

I’ll tell you what it is…but only after you’ve finished your breakfast.

A MOST UNUSUAL TRANSPLANT

Doctors know that healthy gut functioning requires a good balance of the right kinds of bacteria. They theorized that a C. diff. infection could be banished by recolonizing the gut with a normal mix. This could be done by simply transplanting the feces of a healthy person into the colon of the sick person. (I know it sounds disgusting, but stay with me—the process actually is quite interesting!)

The first reported experiments using this technique, back in the 1950s, were quite successful. But it has taken a long time for most practitioners of modern medicine to embrace it, probably due to “the yuck factor,” said Robert Orenstein, DO, associate professor of medicine in the division of infectious diseases at the Mayo Clinic in Phoenix. But savvy and suffering C. diff. patients started to demand it, and after years of referring patients to other medical practices to try fecal transplant, the Mayo Clinic in Arizona started offering the procedure in 2011—and doctors there have been performing an increasing number since then. The Mayo Clinic in Rochester, Minnesota, has followed suit.

Patients with a confirmed C. diff. infection should first try a course of standard therapy with antibiotics directed at eliminating C. diff, Dr. Orenstein said. “An antibiotic such as metronidazole (Flagyl) cures 70% to 90% of the initial infections,” he told me—and it is inexpensive (less than $100 for 10 days of treatment) compared with other antimicrobials for C. diff. such as oral vancomycin (Vancocin) or fidaxomicin (Dificid), which can cost more than $2,500 for 10 days of treatment. Fecal transplants are much more involved (as you’ll see below) and more expensive—but if a patient is not cured after the first two attempts with antibiotics, it’s probably the way to go, he said.

ONE PECULIAR PROCESS

The most awkward step in the fecal transplant process involves finding a stool donor. There is no donor bank for this stuff. Most patients ask friends or family members to provide the sample. Fecal donors are screened via a standardized questionnaire to ensure they don’t have diarrheal or gastrointestinal diseases. They undergo testing for transmissible infectious diseases such as hepatitis and HIV, as well testing for “bad” gut bacteria and parasitic infections.

If donors pass inspection, they arrive the morning of the procedure with a fresh stool sample, “the bigger the better,” said Dr. Orenstein. The optimal transplant volume hasn’t yet been determined, and a range seems to work, but a larger sample gives doctors more to work with. Medical personnel then process the sample, blending it with saline to homogenize and liquefy it, and put it into syringes.

For the C. diff. sufferers, the procedure is much like a colonoscopy—and if they are healthy enough to undergo it and can find a stool donor, there are few other disqualifying factors. (If you’ve recently had a bone marrow transplant, for example, you will likely need to wait before receiving a fecal transplant.) Patients are usually sedated and then they have a scope threaded into the colon. The transplant material is delivered to the colon through the scope. Some doctors use naso-gastric tubes instead (yes, meaning feces in a tube that goes through the nose and into the intestines), and this seems to work just as well, said Dr. Orenstein. (This, as you would imagine, tends to be more unpleasant for the patient, but it’s less expensive and there have been no reports of adverse effects from doing the procedure this way, said Dr. Orenstein.) “About 90% of patients are cured as a result of a fecal transplant,” said Dr. Orenstein.

Compared with a single course of antibiotics, a fecal transplant is labor-intensive and not cheap, if it’s done right. The full screening of potential donors, the processing and the procedure all together can easily run a few thousand dollars, though insurance may cover most of the cost. Beware of doctors who charge a few hundred dollars to do this kind of transplant—they probably are not properly screening donors and/or following infection control practices, said Dr. Orenstein.

THE FUTURE OF FECES IN MEDICINE

“There’s a lot of speculation about doing fecal transplants to treat a variety of illnesses associated with alterations of the gut microbiome, such as ulcerative colitis,” said Dr. Orenstein. “I think it still needs to be studied a lot more.” For now, at least for C. diff., the treatment seems safe and effective, and rejection is not an issue (as it can be with organ donation).

Beyond the two Mayo Clinics, the treatment is done at several other health-care institutions across the country. Many gastroenterologists in private practice have begun to offer this as well.

“C. diff is so destructive to peoples’ lives,” said Dr. Orenstein. “To do something that gives the vast majority of them their life back is very rewarding. Within two days of the procedure, most people are cured and feel like they are back to normal.”