Vipul Nayi, MD, Lawrence Brandt, MD, MACG, Olga Aroniadis, MD, MSc
Montefiore Medical Center, Bronx, NY
Introduction: FMT has been shown to be a highly effective therapy for rCDI. It has been proposed that giving loperamide prior to FMT could further improve the effectiveness of FMT for rCDI because it can increase the amount of time donor stool is in contact with the recipient’s colon before being expelled. Older studies, however, suggest that the use of loperamide during CDI may predispose to megacolon. The goal of this study was to evaluate whether loperamide given before FMT for treatment of rCDI, improves resolution rates.
Methods: A retrospective observational cohort study was conducted at Montefiore Medical Center in the Bronx, NY of pts 18-75 yrs old who underwent FMT for treatment of rCDI from 2014 to 2017. rCDI was defined as ≥3 bouts of CDI with recurrence of symptoms within 8 weeks of completion of antibiotic therapy. Participants were excluded if they had severe or complicated CDI; had IBD, IBS or a motility disorder; were immunocompromised; or did not complete the follow-up telephone survey. Data pertaining to loperamide use before FMT and resolution of diarrhea were obtained by chart review and telephone survey of participants. Cure of rCDI was defined as resolution of diarrhea at 8 weeks of FMT. Bivariate analyses were performed to compare rCDI cure rates and adverse events between those who did and did not take loperamide before FMT.
Results: 15 pts who underwent FMT for rCDI met inclusion criteria. Most participants were female (n=12, 80%). Mean age was 53±20 yrs. Participants had undergone an average of 2.5±0.7 different courses of antibiotics before FMT. 14 of 15 pts reported resolution of diarrhea at 8 weeks (93%). 6 of the 15 pts took loperamide peri-procedurally (40%), all of whom experienced cure of rCDI compared with 8 of 9 pts who did not take loperamide (100% vs 89%, respectively; p >0.99). Pt-reported FMT-related adverse events included subjective fever (n=2, 13.3%), lactose intolerance (n=1; 0.7%), celiac disease (n=1, 0.7%) and rectal bleeding (n=1, 0.7%), all of which occurred in the group who did not take loperamide.
Discussion: In our cohort, FMT was highly successful for the treatment of rCDI. rCDI cure was similar between groups who did and did not receive loperamide, which may be attributable to the overall high rCDI cure rates reported. In our small study, loperamide did not result in increased FMT-related adverse events. A future trial randomizing patients with rCDI to loperamide vs placebo might provide additional insight.
Citation: Vipul Nayi, MD, Lawrence Brandt, MD, MACG, Olga Aroniadis, MD, MSc. P0138 - THE ROLE OF LOPERAMIDE IN CONJUNCTION WITH FECAL MICROBIOTA TRANSPLANTATION (FMT) FOR RECURRENT CLOSTRIDIOIDES DIFFICILE INFECTION (RCDI). Program No. P0138. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.