S517 Comorbid Psychiatric Conditions Are Associated With Increased Risk of Gastrointestinal Symptoms Following Successful Fecal Microbiota Transplantation for Clostridioides difficile Infection

Abstract

Introduction: Fecal microbiota transplantation (FMT) is recommended forprevention of recurrent Clostridioides difficile infection (CDI). Our group has shown that irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) have been associated with gastrointestinal symptoms following FMT. Additionally, psychiatric comorbidities (PC) are associated with functional gastrointestinal disorders. The impact of PC on gastrointestinal symptoms after FMT is unclear. Methods: This is a retrospective cohort study of patients who underwent successful FMT for recurrent CDI defined as absence of diarrhea or negative CDI testing 8 weeks following FMT. Data regarding CDI and psychiatric history were collected. Patients were assessed after FMT for CDI cure and gastrointestinal symptoms (abdominal pain, bloating, flatulence, loose stools, and constipation). The primary outcome was association of PC with any gastrointestinal symptom and secondary outcome was association of PC with the symptom of greatest significance on univariate analysis. Multivariate logistic regression with a priori dependent variables of IBS and IBD was performed for each outcome with a Bonferroni-adjusted P-value threshold of 0.025 for multiple hypothesis testing. Results: 158 patients who underwent a successful FMT were identified. PC were present in 31 (20%) patients, including anxiety (n=12), depression (n=11), bipolar disorder (n=1), post-traumatic stress disorder (n=2), or multiple diagnoses (n=5). Of these, 30 (96%) were prescribed psychotropic medication at time of FMT, 25 (80.7%) were female, and the median (IQR) age was 59 (40-73). No significant differences were present among clinical factors between patients with and without PC. On univariate analysis, patients with PC experienced any gastrointestinal symptom (67.7% vs 44.1%, P=0.02), abdominal pain (25.8% vs 4.7%, p < 0.001), and bloating (12.9% vs 3.2%, p = 0.03) at higher rates post FMT. Adjusted for pre-existing IBS and IBD, patients with PC were more likely to have any gastrointestinal symptoms (OR 2.67, 95% CI: 1.14-6.28), or just abdominal pain (OR 9.01, 95% CI: 2.48-32.71) following FMT. Conclusion: Gastrointestinal symptoms may develop following recurrent CDI even after cure is achieved with FMT. We find that PC are significantly associated with the presence of gastrointestinal symptoms such as abdominal pain following successful FMT. Patients should be assessed pre-FMT for PC so appropriate counseling can be performed.Table 1.: Predictors of Having Bloating in the Past Seven Days (N=88,969) Note: Data are presented as n (% of row). The logistic regression model adjusted for all variables listed in the table, as well as age, gender, race/ethnicity, BMI, education level, marital status, employment status, total household income, tobacco use, alcohol use, US region, insurance status, COVID positive status, self-reported comorbidities diagnosed by physician (GI cancer, celiac disease, cirrhosis, Crohn's disease, diabetes, diverticulitis, endometriosis, fibromyalgia, gastroenteritis, gastroparesis, HIV, multiple sclerosis, pancreatitis, Parkinson's disease, peptic ulcer disease, thyroid disease). 'a' Symptoms in the past seven days