By Sari Harrar, AARP September 2024
Antibiotics can sometimes lead to an overgrowth of this dangerous intestinal bug. But a newly approved treatment can bring order back to your digestive system.
Freda Pyles’ road trip from Wichita, Kansas, to her home in Pennsylvania was a nightmare. Severe diarrhea meant urgent bathroom breaks at every rest stop for hundreds of miles. In Ohio, her husband took her to an emergency room. “I was dehydrated. My kidneys were shutting down,” says Pyles, 76, of her 2021 ordeal. “I couldn’t walk.”
Pyles was infected with Clostridioides difficile (commonly known as C. diff or C. difficile) — a highly contagious germ that kills 30,000 Americans annually, most of them older adults. The infection took hold when an antibiotic prescribed for a tooth infection killed beneficial bacteria in her intestines that can normally keep C. diff in check.
A gold standard C. diff treatment, the antibiotic vancomycin, brought her a little relief but quickly set the stage for more trouble. It further wiped out protective gut bacteria, allowing tough C. diff spores to grow, release diarrhea-triggering toxins and kick-start a new infection.
Back home in rural Russell, Pennsylvania, Pyles spent her days in a chair close to the bathroom. She stopped gardening, keeping bees, swimming at the local YMCA and helping her husband take care of the couple’s flock of chickens. For four months she had recurrent C. diff infections. It’s a dangerous cycle that affects about 35 percent of older adults after a first bout of C. diff and kills 1 in 4 of them, according to a 2022 Yale University study of Medicare beneficiaries.
“By January I had lost 45 pounds, could hardly walk to the bathroom and had fallen a couple of times,” she says. “My husband was really worried. He told a friend he was slowly watching me die.”
In February 2022, Pyles and her husband drove to New Haven, Connecticut, for the treatment. Pyles first received a potent antibiotic to halt her infection (it also allowed her to sit in a car for the seven-hour trip). When she arrived in New Haven, she underwent a treatment she likens to an enema. “You receive this small bag of good bacteria and lie there for about 45 minutes. It just went in. And all those good bacteria went to work.”
In November 2022, the treatment — Rebyota — became the first fecal microbiota product approved by the U.S. Food and Drug Administration (FDA) and the first against recurrent C. diff.
“We’re giving the microbiota a boost,” says gastroenterologist Paul Feuerstadt, M.D., an associate clinical professor at Yale University School of Medicine who studied the treatment and provided Pyles’ transplant. “We’re allowing a healthy, diverse microbiota to grow and become strong in a much more expedited way. It’s a real game changer.”
In studies of people with recurrent C. diff, a fecal microbiota transplant was effective at stopping repeat infections for 80 percent of them at eight weeks, and 92 percent hadn’t had a recurrence two years later.
Fecal transplants aren’t new; they were used for severe diarrhea 1,600 years ago in China. Researchers have been studying them since the 1950s, not only for C. diff but for other digestive problems like irritable bowel syndrome and ulcerative colitis, depression, anxiety and diabetes. Specialists have used them against severe, repeat C. diff for over 10 years, and medical guidelines have recommended them for that use since 2017.
But Feuerstadt notes that having FDA-approved C. diff treatments is a major advance. In 2023, the FDA OK’d a second fecal microbiota treatment for C. diff. Called Vowst, it’s in the form of capsules taken by mouth.
“The difference between FDA-approved products and non-FDA approved is that we know what we are administering,” Feuerstadt says. “We have a much higher level of sophistication. We’re seeing an evolution. This could be used much earlier in recurrent C. diff and by physicians in the community, not just by specialists. It shuts down recurrence. And it lifts the burden of anxiety, depression and fear that people with recurrent C. diff have.”
Pyles says she felt better so quickly after her fecal transplant that she and a friend went out the very next day for a manicure, shopping and dinner with their husbands. She’s now tending four beehives and back to exercising at her local Y. “I skipped swimming this morning,” she said during an interview in June. “I had to get home to get the brussels sprouts in the garden.
Other innovations in digestive health
New hope for Crohn’s disease:
The first FDA-approved pill for Crohn’s disease, upadacitinib (Rinvoq), blocks enzymes that play a role in inflammation. In studies, 39 to 50 percent of Crohn’s patients who hadn’t responded to other treatments went into remission after 12 weeks.
A vibrating pill for constipation:
First available in 2023, FDA-cleared Vibrant capsules start vibrating to stimulate the colon about 14 hours after they’re swallowed. They’re about the size of a multivitamin, and contain a battery and motor. In a 2023 study of 312 people with chronic constipation, 39 percent had an extra weekly bowel movement and 23 percent had two after taking the capsules five times a week for eight weeks. The prescription-only capsules stimulate the intestinal walls to contract and are eliminated from the body naturally.
A remote-controlled camera in a pill:
George Washington University researchers are fine-tuning a camera pill that can be steered — so it’s not just tumbling on its own. In a 2023 study, they used a magnet and joysticks to move the capsule around in the stomachs of 40 volunteers. The pill camera didn’t miss any high-risk lesions. Eighty percent of the volunteers preferred it over a standard endoscopy.
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