Elisabeth Norin Project

Faecal transplant against Clostridium difficile diarrhoea

Clostridium difficile associated disease is today probably the major cause of antibiotic associated diarrhoea and colitis. We have inoculated a culture of faecal microbes originating from a healthy donor, cultivated under strict anaerobic conditions for years, and we manage to cure a high number of patients.

Antibiotic treatment with metronidazol or vancomycin is most often used with good results in the primary infection of Clostridium difficile associated disease (CDAD), but in patients with relapses, the effect has been less favorable, even if a tapering scheme with vancomycin quite often result in improvement. However, relapse without another course of antibiotics has been reported in as much as 30% of the CDAD patients, and these relapses are difficult to eliminate. As an example, other probiotics have been tested, however, without any significant effect.

In earlier studies clindamycin and cephalosporins have been the antibiotics most prone to select for CDAD, but since 2000 treatment with fluoroquinolones has also resulted in frequent CDAD development, particularly in Canada and US. The last years, transplantation of faeces from a close relative have been discussed and sometimes used as a possible treatment in still relapsing patients (1, 2). Faeces transplantation is nowadays becoming increasingly accepted as an effective and safe intervention in patients with recurrent disease, likely due to a restoration of a disrupted intestinal microbiome. This process is an expensive and time consuming process  you have to screen the donor with regard to health condition and absence of pathogenes.

Within our group, we have a culture originating from one healthy adult donor´s faeces which have been investigated for absence of hepatitis A, B and C, Cytomegalovirus, EpsteinBarr virus, HIV, Rotavirus, Calicivirus, Salmonella, Shigella, Campylobacter, Yersinia and Clostridium difficile. This culture has been recultivated on freeze-dried hen yolk medium containing cholesterol for years under a strict anaerobe conditions - ACHIM (Anaerobic Cultivated Human Intestinal Microflora).

The ACHIM culture has over the years been given as a 30 cc suspension by a 50 cm rectal catheter without prior laxation or by nasogastric tube to many CDAD patients which have terminated their antibiotics 13 days prior to transplantation, both in Norway and in Sweden and there is a cure rate of up to 90% (3, 4).

Elisabeth Norin - Associate Professor
Tore Midtvedt - Professor emeritus
PhD, MD - Peter Benno and Bo Tjellström


A published book: "Gastrointestinal Microbiology"
Editors; Arthur C. Ouwehand Health and Nutrition, Danisco Finland, Finland, Elaine E. Vaughan Wageningen University, Vlaardingen, Netherlands.

Elisabeth Norin & Tore Midtvedt have written a chapter; "Born germ-free - microbial dependent"

Read the introduction (pdf file)


Frederik E. Juul, Kjetil Garborg, Michael Bretthauer, Hilde Skudal, Mari N. Øines, Håvard Wiig, Øystein Rose, Birgitte Seip, J. Thomas Lamont, Tore Midtvedt, Jørgen Valeur, Mette Kalager, Øyvind Holme, Lise Helsingen, Magnus Løberg, Hans-Olov Adami. Fecal Microbiota Transplantation for Primary Clostridium
difficile Infection. The New England Journal of Medicine June2018. DOI: 10.1056/NEJMc1803103

From IBS to DBS: The Dysbiotic Bowel Syndrome.
Benno P, Dahlgren A, Befrits R, Norin E, Hellström P, Midtvedt T
J Investig Med High Impact Case Rep ;4(2):2324709616648458

A Role for Bacteria in Celiac Disease?
Tjellström B, Högberg L, Stenhammar L, Magnusson K, Midtvedt T, Norin E, et al
Dig. Dis. Sci. 2016 07;61(7):2140-1

[Underlying dysbiosis may be the cause of some forms of IBS. Patients were free of symptoms after the administration of microbiota].
Benno P, Befrits R, Berstad A, Dahlgren A, Norin E, Midtvedt T
Lakartidningen 2015 Jun;112():

Experience with cultivated microbiota transplant: ongoing treatment of Clostridium difficile patients in Sweden.
Norin E
Microb. Ecol. Health Dis. 2015 ;26():27638

Is irritable bowel syndrome a dysbiotic bowel syndrome?
Benno P, Befrits R, Norin E, Berstad A, Dahlgren A, Midtvedt T, et al
Microb. Ecol. Health Dis. 2015 ;26():27637

Exclusive Enteral Nutrition Does Not Normalize Gut Microflora Function in Pediatric Perianal Crohn Disease.
Tjellström B, Stenhammar L, Magnusson K, Midtvedt T, Norin E, Sundqvist T, et al
J. Pediatr. Gastroenterol. Nutr. 2015 Jul;61(1):e4

The effects of oats on the function of gut microflora in children with coeliac disease.
Tjellström B, Stenhammar L, Sundqvist T, Fälth-Magnusson K, Hollén E, Magnusson K, et al
Aliment. Pharmacol. Ther. 2014 May;39(10):1156-60

Response to Surawicz et al.
Midtvedt T, Norin E, Benno P, Dahlgren A
Am. J. Gastroenterol. 2013 Dec;108(12):1931-2

Faecal short-chain fatty acid pattern in childhood coeliac disease is normalised after more than one year's gluten-free diet.
Tjellström B, Högberg L, Stenhammar L, Fälth-Magnusson K, Magnusson K, Norin E, et al
Microb. Ecol. Health Dis. 2013 ;24():

Increase of faecal tryptic activity relates to changes in the intestinal microbiome: analysis of Crohn's disease with a multidisciplinary platform.
Midtvedt T, Zabarovsky E, Norin E, Bark J, Gizatullin R, Kashuba V, et al
PLoS ONE 2013 ;8(6):e66074

Effect of exclusive enteral nutrition on gut microflora function in children with Crohn's disease.
Tjellström B, Högberg L, Stenhammar L, Magnusson K, Midtvedt T, Norin E, et al
Scand. J. Gastroenterol. 2012 Dec;47(12):1454-9

Fecal transplant against relapsing Clostridium difficile-associated diarrhea in 32 patients.
Jorup-Rönström C, Håkanson A, Sandell S, Edvinsson O, Midtvedt T, Persson A, et al
Scand. J. Gastroenterol. 2012 May;47(5):548-52

Major alterations in metabolic activity of intestinal microflora in Crohn's disease.
Benno P, Bark J, Collinder E, Hellström P, Midtvedt T, Norin E
Scand. J. Gastroenterol. 2012 Feb;47(2):251-2

Determinants of the human infant intestinal microbiota after the introduction of first complementary foods in infant samples from five European centres.
Fallani M, Amarri S, Uusijarvi A, Adam R, Khanna S, Aguilera M, et al
Microbiology (Reading, Engl.) 2011 May;157(Pt 5):1385-92

Assessment of microbial fermentation products in fecal samples.
Valeur J, Norin E, Midtvedt T, Berstad A
Neurogastroenterol. Motil. 2010 Oct;22(10):1147

Screening-detected and symptomatic untreated celiac children show similar gut microflora-associated characteristics.
Tjellström B, Stenhammar L, Högberg L, Fälth-Magnusson K, Magnusson K, Midtvedt T, et al
Scand. J. Gastroenterol. 2010 Sep;45(9):1059-62

Intestinal microbiota of 6-week-old infants across Europe: geographic influence beyond delivery mode, breast-feeding, and antibiotics.
Fallani M, Young D, Scott J, Norin E, Amarri S, Adam R, et al
J. Pediatr. Gastroenterol. Nutr. 2010 Jul;51(1):77-84

Publications 2002-2009

Publications 2002-2009 (pdf)

Publications 2002

Publications 2002 (Pdf file, 25 Kb)

Publications 2000/2001

Publications 2000/2001 (Pdf file, 24 Kb)

Publications 1999

Publications 1999 (Pdf file, 23 Kb)

Project Members

  PhD, MD Bo Tjellström