Three Factors Identify Risk of Fecal Transplant Failure for C. Diff Infections

Monika Fischer, MD, MSCR Assistant Professor of Clinical Medicine Division of Gastroenterology and Hepatology Indiana University Indianapolis, IN 46202

Dr. Monika Fischer

MedicalResearch.com Interview with:
Monika Fischer, MD, MSCR
Assistant Professor of Clinical Medicine
Division of Gastroenterology and Hepatology
Indiana University
Indianapolis, IN 46202 

Medical Research: What is the background for this study? What are the main findings?

Dr. Fischer: Cumulative evidence based upon case series and randomized trials suggest high success rate with 10-20 % failing a single FMT (fecal microbiota transplant). Predictors of failures are not known. In a collaborative study between Indiana and Brown Universities we aimed to identify clinical predictors of FMT failure.

Results were the following:

  • N= 345 patients
    • Brown: N=166
    • IU: N=179
  • Average age: 62 years
  • Females: 72%
  • IBD: 18%
  • Immunosuppression: 24%
  • Indication for FMT
    • Recurrent CDI: 74%
    • Refractory CDI: 26%
    • Severe/complicated CDI: 13%
  • Inpatient FMT: 17%
  • Patient directed donor: 40%

Overall failure rate was 23.7%. Broken down by fecal microbiota transplant indication, while only 18% of patients failed and  needed further therapy in the non-severe category, 1 in 2 (50%) severe C. difficile infection (CDI) patients failed a single fecal microbiota transplant and needed further therapy for cure.

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Safety Net Hospital Improves Colon Cancer Screening in Primary Care Setting

Elizabeth Broussard, MD Clinical Assistant Professor Division of Gastroenterology Harborview Medical Center Seattle, WA 98105MedicalResearch.com Interview with:
Elizabeth Broussard, MD
Clinical Assistant Professor
Division of Gastroenterology
Harborview Medical Center
Seattle, WA 98105

Medical Research: What is the background for this study? What are the main findings?

Dr. Broussard: I am a clinical assistant professor of gastroenterology and I practice and teach fellows and residents GI at a safety-net hospital in Seattle and I was seeing too many late stage colorectal cancer (CRC) in our patient population. CRC is preventable with screening, and I wanted to see how the primary care clinics were performing in getting patients screened. When I looked at the baseline percentages, I realized this was an opportunity for improvement. I teamed up with an internal medicine resident Kara Walter, and we did a deep dive into the process of screening. The results of the poster presentation are a product of this teamwork, with cooperation and input from the directors of the six primary care clinics at our hospital. The main findings are that performing the FIT test is complicated and tricky for some patients, that this process can be streamlined with providing a toilet hat, a prepaid postage envelope, and improved and visual instructions. After one year, we saw statistically significant increases in overall screening with FIT in our patient population.

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Microbiome Signature Can Predict Risk of C. difficile Treatment Failure

Dr. Sahil Khanna MBBS Assistant Professor of Medicine Mayo Clinic

Dr. Sahil Khanna

MedicalResearch.com Interview with:
Dr. Sahil Khanna MBBS
Assistant Professor of Medicine
Mayo Clinic

Medical Research: What is the background for this study? What are the main findings?

Response: C. difficile infection patients are at a high risk of complications such as treatment failure. Gut microbiota signatures associated with CDI have been described but it is unclear if differences in gut microbiota play a role in response to therapy. No studies have identified predictors of treatment failure and we aimed to identified gut microbiota signatures to predict response to treatment for primary C. difficile . While there were no clinical predictors of treatment response, there were increases in certain genera in patients with successful treatment response in the fecal samples at initial diagnosis compared to non-responders. A risk index built from this panel of microbes highly differentiated between patients based on response and ROC curve analysis showed that this risk index was a strong predictor of treatment response, with a high area under the curve of 0.83..

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Chronic Constipation May Be Manifestation of Depression

Kyle Staller, MD, MPH Massachusetts General Hospital Harvard Medical School

Dr. Kyle Staller

MedicalResearch.com Interview with:
Kyle Staller, MD, MPH
Massachusetts General Hospital
Harvard Medical School

Medical Research: What is the background for this study? What are the main findings?

Dr. Staller: Constipation is exceedingly common and exerts a considerable economic effect.  Although many clinicians assume that the severity of constipation symptoms is the primary driver of obligation absenteeism, our data from over 100 patients undergoing physiologic evaluation for chronic constipation demonstrates that comorbid depression was a bigger predictor or work and school absenteeism than symptom severity and quality of life.
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Some Non-Obese Adults Still Have Metabolic Syndrome

Robert Wong, M.D., M.S. Attending Physician, Gastroenterology & Hepatology Director, GI Education & Research Highland Hospital A member of Alameda Health System Oakland, CA 94602MedicalResearch.com Interview with:
Robert Wong, M.D., M.S.
Attending Physician, Gastroenterology & Hepatology
Director, GI Education & Research
Highland Hospital A member of Alameda Health System
Oakland, CA 94602

Medical Research: What is the background for this study? What are the main findings?

Dr. Wong: The rising prevalence of obesity and diabetes has led to concurrent rise in metabolic syndrome in the U.S.  Identifying metabolic syndrome is important to implement targeted treatment as metabolic syndrome contributes to cardiovascular disease, nonalcoholic fatty liver disease, and overall mortality.  However, while obesity is a major risk factor for metabolic syndrome, out study highlights the importance of considering metabolic syndrome even in individuals who do not meet criteria for obesity.  We demonstrated that nearly 20% of adults who do not meet current definitions of obesity still have metabolic syndrome in the U.S.

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Women and Southern States Account For Majority of Morbid Obesity Admissions

Salman Nusrat M.D. Assistant Professor, Section of Digestive Diseases and Nutrition University of Oklahoma Health Sciences CenterMedicalResearch.com Interview with:
Salman Nusrat M.D.
Assistant Professor, Section of Digestive Diseases and Nutrition
University of Oklahoma Health Sciences Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Nusrat: Obesity is a global epidemic and is one of the most taxing issues affecting healthcare in the United States. It is a well-established risk factor for increased morbidity and mortality. We looked at how morbid obesity (BMI>40) affected inpatient health care utilization over the last two decades. We found that:

  • From 1997 to 2012, the number of patients discharged with a diagnosis of morbid obesity increased 11 folds from 10,883 to 124,650
  • The majority of these patients were female (~80%) and aged between 18-44 years.
  • Southern States accounted for majority of these admissions (37%). Majority of these patients were insured (~90%) and about three quarters of these admissions were in area with mean income above the 25 percentile.
  • The number of hospitalizations for patients aged >45 years increased from 33% to 50%.
  • -Even though the length of stay decreased from 5 days (1997) to 2.1 days (2012), the aggregate charges increased from $198 Million (1997) to $5.9 Billion (2012).

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