Fecal Microbiota Transplantation in Recurrent Clostridium Difficile Infections: Our Experience in Patients with and without Inflammatory Bowel Disease

Abstract

Purpose: Fecal microbiota transplantation (FMT) has been used to reintroduce typical microbiota to reestablish balance in the setting of recurrent Clostridium difficile infection (CDI). The purpose of this study was to assess the safety and efficacy of FMT with concurrent CDI and inflammatory bowel disease (IBD).Methods: This is a retrospective study performed at Med Star Georgetown University Hospital reviewing all patients with a history of recurrent CDI that were treated with FMT between December 1st, 2012 to August 30th, 2015. Results:We identified 42 patients with recurrent CDI who were treated with FMT. Nine of the 42patients had IBD. At 48 hours after FMT, 38 patients experienced resolution or improvement of diarrhea, 1 patient had persistent diarrhea and abdominal pain, and 3 patients had no documentation of symptoms reported. Eleven of the 24 patients experienced abdominal pain prior to FMT, and 9 of these patients had resolution or improvement. Of the 9 patients with IBD, 5 had resolution of diarrhea, and 1 had a repeat episode of CDI, 1 required surgery, and 2 or undocumented. Of the four patients with IBD that had abdominal pain, all experienced resolution or improvement initially, with one that recurred with resolution after another dose of vancomycin. Conclusion:Recent studies have shown FMT as a successful treatment of recurrent CDI. There are ongoing studies evaluating the benefit of FMT in the treatment of IBD but there is limited evidence that FMT reduces symptoms in IBD. Of the 9 patients treated with FMT with concurrent IBD, all reported resolution of diarrhea and improvement in abdominal pain initially with FMT. Further studies are needed to assess these patients long term benefits after FMT and correlation with IBD flares as well.Keywords: Recurrent clostridium difficile infection; Fecal microbiota transplantation; Inflammatory bowel disease therapy for patients with recurrent disease to reintroduce typical microbiota and reestablish balance [1,3,5].One longstanding theory of IBD pathogenesis includes disruption of the intestinal wall and immune dysregulation against altered commensal gut bacteria [6]. Patients with IBD are highly susceptible to CDI due to immunosuppressive agents used for treatment, intermittent hospital courses, and altered gut microbiota as well [7]. Currents studies are underway to determine the safety and efficacy of FMT in the treatment of CDI in this population. Kelly et al. [7] noted 89% of immunocompromised patients that underwent FMT were asymptomatic after treatment [7]. However, there are mixed outcomes in anecdotal reports and small studies utilizing FMT in patients with IBD [ 7,[10][11][12][13].It remains unclear whether the dysbiosis in patients with IBD causes the disease manifestations or is a result of the active inflammation [14]. Questions also remain as to the optimal FMT scheduling protocol, route of administration, and appropriate diseases for FMT use. In this study, we describe our experience with FMT in treating patients with recurrent and r...