Emilie (E.) Van Lingen

Credit: Linkedin

Fecal microbiota transplantation (FMT) for recurrent clostridiodes difficile infections (CDI) could help reduce the risk of future flares for patients with inflammatory bowel disease (IBD).¹

A team, led by Emilie (E.) Van Lingen, Department of Gastroenterology and Hepatology, Leiden University Medical Center (LUMC), identified the factors that influence the clinical outcomes and course for both recurrent CDI and IBD.

Patients with IBD are often at an increased risk of CDI. However, treatment in this patient population can be challenging, often because of higher failure rates and concomitant IBD activity.

“The reduced diversity and perturbed gut microbiota in IBD patients may predispose or affect disease course in CDI,” the authors wrote. “Distinguishing an active episode of CDI from an IBD flare is a clinical challenge because symptoms are overlapping, which is complicated by a higher incidence of asymptomatic colonization in IBD patients.”

There are several known risk factors for CDI, including older age, severe underlying illnesses, antimicrobial therapy, hospital stay, and the use of proton pump inhibitors.

In the multicenter cohort, the investigators examined 113 patients with IBD who received FMT for recurrent CDI in 5 European FMT centers.

The mean age of the patient population was 48 years and 64% had ulcerative colitis.

The investigators sought main outcomes of the cure of a CDI, determined 8 weeks after FMT and defined as a clinical resolution of diarrhea or diarrhea with a negative C. difficile test.

The investigators defined cure as the clinical resolution of diarrhea or diarrhea with a negative C difficile test and defined IBD flares as record based.

They also collected long-term follow-up data including new episodes of CDI, IBD flares, infections, hospital admissions, and death.

The results show concomitant recurrent CDI was associated with an IBD flare in 54% of participants. Of this group, 63% received IBD remission-induction therapy before FMT.

In addition, all FMT procedures were preceded by vancomycin treatment and 40% of patients received FMT via a colonoscopy. The CDI cure rate was 71%.

The final analysis included long-term follow-up data for 90 patients with a median follow-up of 784 days.

IBD activity decreased in 39% of patients with active IBD at baseline, while an IBD flare occurred in only 5% of patients.

In the two-year follow-up period, 27% of patients had infections, 39% were hospitalized, 5% underwent colectomy, and 10% died. The median age of patients who died was 72 years.

“FMT for rCDI in IBD patients is safe and effective, and IBD exacerbation after FMT is infrequent,” the authors wrote. “Further studies should investigate the effects on IBD course following FMT.”

References:

van Lingen E (E. ), Baunwall S (S. MD), Lieberknecht S (S. C), et al. Short- and long-term follow-up after fecal microbiota transplantation as treatment for recurrent Clostridioides difficile infection in patients with inflammatory bowel disease. Therapeutic Advances in Gastroenterology. 2023;16. doi:10.1177/17562848231156285