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.