Post-Infectious Irritable Bowel Syndrome Persists After Fecal Microbiota Transplant for C. difficile Infection

Abstract

Introduction: Post-infectious irritable bowel syndrome (IBS-PI) is an increasingly recognized subset of IBS where symptoms arise following an acute gastrointestinal infectious illness. After C. difficile infection (CDI), IBS-PI symptoms can mimic recurrent infection. While fecal microbiota transplant (FMT) has been shown to be effective in reducing recurrence of CDI, reports on FMT’s impact on IBS have been mixed. Little has been reported on FMT’s effects on IBS-PI after CDI. This study aims to describe the experience of IBS-PI patients at our center who have undergone FMT. Methods: All patients at NorthShore University Health System receiving FMT for recurrent CDI were prospectively enrolled in our FMT registry. Demographic and clinical information, including pre-existing gastrointestinal disease, were reviewed. Patients were prospectively followed and queried on their clinical symptoms in the office or by phone at baseline, 24 hours, 7 days, 4 weeks and 6 months after FMT. Results: Between May 2015 and November 2017, 169 unique patients underwent FMT for recurrent or severe CDI (Table 1). The mean age of subjects was 67, and 123 (73%) were female. In total, 79 (46.7%) carried a diagnosis of IBS. Of those with IBS, 47 (27.8%) had documented clinical suspicion of IBS-PI by their GI physician, while 32 (18.9%) had pre-existing IBS. 35/47 (74.4%) of IBS-PI patients had symptoms consistent with IBS-D, 3 (6.4%) IBS-C, 6 (12.7%) IBS-M, and 3 (6.4%) unknown. FMT was effective in preventing CDI relapse in 142/169 (84%) of all patients, and 40/47 (85.1%) patients with IBS-PI. The questionnaire response rate for eligible patients with IBS-PI was 39/47 (83%) at 4 weeks after FMT, and 34/47 (72.3%) at 6 months (Table 2). At 4 weeks, 25 (64.1%) reported semi-formed, mushy/soft or loose stools, and 8 (20.5%) reported abdominal pain. At 6 months, 22 (64.7%) reported diarrhea, while 13 (38.2%) reported abdominal pain. 17 (39.5%) were treated with probiotics, 9 (20.9%) on dicyclomine, 7 (16.2%) on loperamide, and 2 (4.65%) on laxatives. Conclusion: IBS-PI is common in patients presenting for FMT for recurrent CDI. Response to FMT is similar amongst IBS-PI and non-IBS patients. However, almost 2/3 of IBS-PI patients continue to experience diarrheal symptoms up to 6 months after FMT, suggesting the limited role of FMT in IBS-PI. These results are relevant when setting expectations regarding symptom relief with the procedure. Further studies regarding IBS-PI management after recurrent CDI are needed.166_A Figure 1 No Caption available.166_B Figure 2 No Caption available.