P0140 - Bowel Preparation Before Oral Fecal Microbiota Transplant for the Treatment of Recurrent Clostridioides difficile Colitis Does Not Reduce Recurrence

Jason Wagner, MD, Wasay Mohajir, DO, Amber Chen, BSc, Farrah Rahim, BSc, Zubair Khan, MD, Andrew DuPont, MD
University of Texas Health Science Center at Houston, Houston, TX

Introduction: Fecal microbiota transplantion (FMT) is effective for the treatment of recurrent or refractory Clostridiodes difficle infection (rCDI). Bowel lavage is typically used prior to oral FMT, however, there is little data demonstrating that its use improves clinical outcomes. In this study, our aim was to determine if bowel lavage performed prior to oral FMT for rCDI increases rates of successful eradication at 2 months post-FMT.

Methods: This is a retrospective, single-center, cohort review study performed on 60 adult patients who received oral FMT for treatment of rCDI. Patients were included if they were ≥18 years of age and diagnosed with rCDI that had recurred after receiving anti-CDI antibiotics at least twice. At our institution, a change in nursing supervisors led to failure to instruct 36 patients on the need for pre-FMT bowel lavage. Before re-instituting the procedure, recognizing the lack of scientific evidence for bowel lavage prior to oral FMT, we wanted to examine the comparative efficacy of the two groups. Electronic medical records were used to obtain information about recurrence or persistence of CDI, diagnosed during the 2 month period post-FMT. Odds ratios were used to determine the odds of recurrence. Few differences were observed between patients who did not receive bowel lavage relative to those who did. However, to control for these differences, multivariate logistic regression was used.

Results: Overall, 40% (n=24) of patients had a bowel lavage prior to oral FMT. Of those patients, 17% (n=4) developed recurrent or persistent CDI post-FMT by 2 months follow-up, compared to 17% (n=6) of those that did not complete a bowel lavage. There was no increase in the odds of recurrence with or without bowel lavage (OR 1.0, 95% CI: 0.2-4.0), even after controlling for differences between the two groups (adjusted OR 0.9, 95% CI: 0.2-3.8). Additionally, patients were no more likely to develop symptoms post-FMT with bowel lavage compared to without (OR 1.2, 95% CI: 0.4-3.8).

Discussion: In this initial analysis, bowel lavage given before oral FMT did not reduce CDI recurrence or persistence. Given that bowel lavage is an unpleasant experience for many patients, it may not be necessary prior to oral FMT for the treatment of rCDI. In the future, we will not use bowel lavage prior to oral FMT for treatment of rCDI.


Disclosures:
Jason Wagner indicated no relevant financial relationships.
Wasay Mohajir indicated no relevant financial relationships.
Amber Chen indicated no relevant financial relationships.
Farrah Rahim indicated no relevant financial relationships.
Zubair Khan indicated no relevant financial relationships.
Andrew DuPont indicated no relevant financial relationships.


Jason Wagner, MD, Wasay Mohajir, DO, Amber Chen, BSc, Farrah Rahim, BSc, Zubair Khan, MD, Andrew DuPont, MD. P0140 - Bowel Preparation Before Oral Fecal Microbiota Transplant for the Treatment of Recurrent Clostridioides difficile Colitis Does Not Reduce Recurrence, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.