It might provoke a reflexive groan of disgust, but fecal transplantation is proving to be one of the most effective remedies for previously difficult-to-treat digestive illnesses, like Clostridium difficile infection (CDI).

Now, a new study published Tuesday in JAMA has found a more practical method of transplantation — utilizing frozen then thawed fecal samples — is just as effective and safe for treating CDIs as using fresh samples. The finding hopefully suggests that in the near future, patients across the country will have wider access to the burgeoning treatment. "Given the potential advantages of providing frozen FMT, its use is a reasonable option in this setting," the authors concluded.

CDIs often occur in hospital patients because of previous antibiotic therapy. The antibiotics, while treating whatever nasty infections happen to be around, also wipe away the good bacteria normally found in our intestines and elsewhere. This disruption to our natural bacterial environment, or microbiota, not only can wreak havoc on our health, but also allows C. diff. to set up shop. Once it does, it becomes very difficult for the body to evict out its unwelcome visitor, even with the help of powerful antibiotics, and it often recurs. In the meantime, CDI leaves its sufferers with repeated bouts of diarrhea and other gastrointestinal issues — in about 6 to 30 percent of hospital-acquired CDI cases, the sufferer eventually dies.

While conventional drugs haven’t worked well against CDIs, the transplantation of fecal material from a healthy person via enema has had overwhelming success, with cure rates as high as 90 percent. These fecal microbiota transplants (FMT) effectively reset the gut bacteria of the recipient, allowing the body to once again crowd out the bug. But while FMTs have proven to be a near-miracle, finding the resources and willingness needed to provide them when needed have been slow-starting.

One suggestion for making the procedure more accessible has been to freeze fecal samples for later use, as opposed to having the donor "drop off" their sample to be used that same day, but there have been worries that this technique might result in less effectiveness or other unforeseen risks. Previous research has validated that the frozen method has a high treatment rate, but it was only with this latest study that the two were compared directly to one another.

The researchers randomized 232 patients with recurrent CDI to receive fresh or frozen FMT at one of six academic medical centers in Canada from July 2012 and September 2014. Of all those who were treated, the success rate was 75 percent for the frozen group vs 70.3 percent for the fresh group. When only looking at people who were given FMTs exactly as prescribed, those rates jumped up to 83.5 percent and 85.1 percent, respectively. Similarly, there was no difference in the amount of side-effects experienced by either group.

Though only one study with a relatively small amount of participants, fellow researchers are excited about the possibilities frozen FMT can open up. “The ability to use frozen stool eliminates many of the logistical burdens inherent to FMT, because stool collection and processing need not be tied to the procedure date and time,” wrote Dr. Preeti N. Malani, Associate Editor for JAMA, and Dr. Krishna Rao in an accompanying editorial. Both Malani and Rao are members of the University of Michigan Health System in Ann Arbor. “This study also provides greater support for the practice of using centralized stool banks, which could further remove barriers to FMT by making available to clinicians safe, screened stool that can be shipped and stored frozen and thawed for use as needed.“

For those interested, you can venture out to Massachusetts and become a fecal donor for the swanky salary of $40 a day, and up to $13,000 a year.

Source: Lee C, Steiner T, Petrof E, et al. Frozen vs Fresh Fecal Microbiota Transplantation and Clinical Resolution of Diarrhea in Patients With Recurrent Clostridium difficile Infection. JAMA. 2016.