S0873 Patient and Gastroenterologist Attitudes of Fecal Microbiota Transplantation as a Treatment for Inflammatory Bowel Disease

Abstract

INTRODUCTION: Fecal microbiota transplantation (FMT) is an attractive therapeutic option for patients with inflammatory bowel disease (IBD). While recent studies have shown benefit of FMT in UC, there are no guidelines for the use of FMT in IBD and current regulations limit FMT to treat C difficile infections. Despite these constraints, patients have used FMT for IBD. Our aim is to assess interest and attitudes of patients as well as current clinical practices and attitudes of gastroenterologists as it relates to FMT as therapy for IBD. METHODS: We performed IRB-approved cross-sectional web-based surveys of both patients and providers at a tertiary IBD center from November 2019 to January 2020. All English-speaking patients ≥18 years old with a self-reported diagnosis of IBD were eligible. RESULTS: 100 patients completed the study, 55% female, 56% with Crohn’s, 39% with UC and 5% with IBD-U (Table 1). 40% of patients had heard about FMT as treatment for IBD, though only 12% had discussed it with their GI. No patients had used FMT, but 17% had considered it for their IBD. Most patients (68%) felt more comfortable discussing FMT with their GI after this survey. Patients’ biggest concern of FMT was risk of infection. When told that the FDA recently reported a death related to drug resistant bacteria from FMT, most (53.3%) patients said this changed the way they felt about FMT. 56 providers (GIs) completed the study, 159 were approached: including 19 GI fellows, 22 General GI and 15 IBD specialists with a median of 14 years (range 0-56) in practice. Only 23% of GIs typically ask patients about FMT to treat IBD, though a majority (75%) report that a patient has previously asked them about FMT. A quarter of providers report that their patients have used FMT to treat IBD. Most GIs (84%) have referred a patient for FMT, most commonly for C difficile. The majority of GIs (86%) would consider entering IBD patients into FMT clinical trials. GIs’ biggest concern of FMT was lack of evidence (Figure 2). CONCLUSION: There was a significant minority (17%) of patients that have considered using FMT as a treatment for IBD, but only 23% of providers are asking their patients about FMT. Patients and providers had very different concerns about FMT, with patients concerned about risk of infection and GIs concerned about lack of evidence and efficacy. There is an opportunity to provide resources to providers to help initiate these conversations, and to educate patients on the risks and benefits of FMT for IBD.Table 1.: Characteristics of the Patient Population. Demographics of a patient population for a survey evaluating the patient perceptions and opinions of patients towards fecal microbiota transplantation (FMT) as a treatment for inflammatory bowel disease (IBD) performed at a single tertiary care centerFigure 1.: Patients' Concerns. Graph of patients concerns' about FMT as a treatment for IBD. For those patients with concerns about FMT we asked them to rank their concerns from biggest concern to least concern.Figure 2.: Gastroenterologists' Concerns. Graph of gastroenterologists' concerns regarding FMT as a potential treatment for IBD. We asked them to rank their concerns from most concerning to least concerning.