Interventional gastroenterology

FMT non-responders might be C. diff pretenders

A proportion of non-responders to faecal microbiota transplantation (FMT) for recurrent C. difficile infection probably have a post-infectious IBS rather than the intestinal infection.

A US study of 135 FMT non-responders found only 30% of patients were assessed for post-infectious IBS.

Commenting on the study, Professor Jane Andrews said the findings suggest accuracy in the diagnosis of C. difficile infection in patients referred for FMT might improve the procedure’s already high (84%) efficacy rate.

“I think the article makes some good conclusions. Many ‘non-responders’ probably did not have rCDI – just ongoing symptoms which are very common after any episode of gastroenteritis.”

“This is also supported by the fact that 70% of ‘non-responders’ are women,” she said.

Professor Andrews, head of IBD Service at the Royal Adelaide Hospital, told the limbic that people with symptoms, but a normal looking colon, probably had IBS.

“A flexi sig or a calprotectin can help and if the person has loose stools or frequency but no pain, no blood and is well with bloods normal, it is probably not C. difficile colitis.”

The study also found 19% of FMT non-responders did not decontaminate C. difficile spores from their toilets after FMT and may therefore have been reinfections rather than non-responders.

They said there was a need for patient education and counselling given molecular typing evidence that up to half of recurrent C. difficile infections were caused by reinfection.

The study also found that some patients receiving FMT via nasogastric tube did not receive pre-therapy proton pump inhibitors to protect the microbiota from gastric acids.

Professor Andrews said access to FMT in Australia was patchy despite the data to support its efficacy and safety. The procedure was not on the Australian Register of Therapeutic Goods (ARTG) or registered with the TGA.

A GESA working party is looking at how FMT might be made more available in a safe and evidence-based fashion.

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