Prevalence of Irritable Bowel Syndrome Symptoms After Fecal Microbiota Transplant for C. difficile

Abstract

Introduction: Fecal microbiota transplantation (FMT) has emerged as a definitive treatment option for recurrent Clostridium difficile infection (CDI). Post-infection Irritable Bowel Syndrome (IBS) is a common complication after infectious gastroenteritis and is frequently observed after CDI. We aimed to examine the prevalence of IBS symptoms after FMT for CDI in patients with and without a prior IBS diagnosis. Methods: Patients who had FMT for treatment of recurrent CDI between August 2011 and October 2017 at The Miriam Hospital (TMH) and Brigham and Woman’s Hospital (BWH) were contacted by telephone at follow up time points at least 6 months post-FMT to assess longer-term safety and efficacy. Baseline patient demographics, prior history of IBS, changes in abdominal symptoms and new medical diagnoses post-FMT were collected. Rome IV Criteria were used to assess for IBS symptoms. Statistical analysis was performed using R statistical software. Results: Data was available for 175 out of 517 identified patients treated (TMH n=88, BWH n=87); the remaining (n=342) had < 6 months of follow up or could not be contacted. The mean follow up time point of symptom assessment post-FMT was 30 months (range 3-75). A total of 33 (19%) patients had a diagnosis of IBS before FMT. Of the 33 patients who had a medical diagnosis of IBS before FMT, 19 (58%) did not meet Rome IV criteria after FMT. 9 (5%) patients had been given a new diagnosis of IBS after FMT. An additional 12 (7%) patients who did not have IBS before FMT had symptoms meeting Rome IV criteria at telephone follow up but did not carry an IBS diagnosis. Patients who did not have a pre-FMT diagnosis of IBS were more likely to have developed new symptoms meeting Rome IV criteria when contacted at time points further out from FMT than those who were telephoned sooner post-procedure (median 37 vs. 24 months) Figure 1. Conclusion: The majority of patients with a diagnosis of IBS appeared to have an improvement in functional symptoms after FMT for C. difficile though new diagnoses of IBS or symptoms consistent with IBS were not uncommon post-FMT. Patients without a pre-FMT IBS diagnosis were more likely to meet Rome diagnostic criteria for IBS at time points further out from the procedure. This finding suggests that IBS symptoms may develop as a long term side effect after FMT, though this finding may be related to length time bias.466 Figure 1. Prevalence of new IBS symptoms after FMT increases at time points further out from the procedure