P1438 - Comorbid Psychiatric Conditions Are Associated With Increased Risk of Gastrointestinal Symptoms Following Successful Fecal Microbiota Transplantation for Clostridioides difficile Infection

Sanchit Gupta, MD, MS¹, Emma L. McClure, BA¹, Jenna Marcus, BS¹, Walter W. Chan, MD, MPH¹, Jessica R. Allegretti, MD, MPH, FACG^2
1Brigham & Women's Hospital, Boston, MA; ²Brigham & Women’s Hospital, Harvard Medical School, Boston, MA

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.

Discussion: 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.

Outcome	Factor	Odds Ratio	95% Confidence Interval	p-value
Any gastrointestinal symptom (abdominal pain, bloating, diarrhea, flatulence, loose stools, constipation)	Psychiatric comorbidity Irritable Bowel Syndrome Inflammatory Bowel Disease	2.67 2.63 1.66	1.14-6.28 1.00-6.96 0.65-4.20	0.02 0.05 0.29
Abdominal Pain	Psychiatric Comorbidity Irritable Bowel Syndrome Inflammatory Bowel Disease	9.01 2.33 4.10	2.48-32.71 0.60-0.06 0.85-19.87	0.001 0.22 0.08

Table: Table 1: Multivariate logistic regression analyses examining the association of psychiatric comorbidities with gastrointestinal symptoms following successful treatment of Clostridiodes difficile infection with fecal microbiota transplantation


Disclosures:
Sanchit Gupta indicated no relevant financial relationships.
Emma McClure indicated no relevant financial relationships.
Jenna Marcus indicated no relevant financial relationships.
Walter Chan: Ironwood Pharmaceuticals – Advisory Committee/Board Member. Takeda Pharmaceutical – Advisory Committee/Board Member.
Jessica Allegretti: Artugen – Consultant. Baccain – Consultant. BMS – Consultant. Finch Therapeutics – Consultant. Iterative Scopes – Consultant. Janssen – Consultant. Merck – Grant/Research Support. Morphic – Consultant. Pandion – Consultant. Pfizer – Consultant. Servatus – Consultant.


Sanchit Gupta, MD, MS¹, Emma L. McClure, BA¹, Jenna Marcus, BS¹, Walter W. Chan, MD, MPH¹, Jessica R. Allegretti, MD, MPH, FACG². P1438 - Comorbid Psychiatric Conditions Are Associated With Increased Risk of Gastrointestinal Symptoms Following Successful Fecal Microbiota Transplantation for Clostridioides difficile Infection, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.