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Updated: Jun 28, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Post-infectious ibs following Clostridioides difficile infection; role of microbiota and implications for treatment
Dana Taghaddos1, Zarwa Saqib1, Xiaopeng Bai2
1Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Abstract:
Up to 25% of patients recovering from antibiotic-treated Clostridioides difficile infection (CDI) develop functional symptoms reminiscent of Post-Infectious Irritable Bowel Syndrome (PI-IBS). For patients with persistent symptoms following infection, a clinical dilemma arises as to whether to provide additional antibiotic treatment or to adopt a conservative symptom-based approach. Here, we review the literature on CDI-related PI-IBS and compare the findings with PI-IBS. We review proposed mechanisms, including the role of C. difficile toxins and the microbiota, and discuss implications for therapy. We suggest that gut dysfunction post-CDI may be initiated by toxin-induced damage to enteroglial cells and that a dysbiotic gut microbitota maintains the clinical phenotype over time, prompting consideration of microbiota-directed therapies. While Fecal Microbial Transplant (FMT) is currently reserved for recurrent CDI (rCDI), we propose that microbiota-directed therapies may have a role in primary CDI in order to avoid or mitigate futher antibiotic treatment that further disrupts the microbiota and thus prevent PI-IBS. We discuss novel microbial transfer therapies and as they emerge, we recommend clinical trials to determine whether microbial transfer therapy of the primary infection prevents both rCDI and CDI-related PI- IBS.
Insights
Up to 25% of patients recovering from antibiotic-treated Clostridioides difficile infection (CDI) develop symptoms similar to Post-Infectious Irritable Bowel Syndrome (PI-IBS). Microbiota-directed therapies, like fecal microbial transplant, may prevent PI-IBS by restoring gut health after primary CDI.
Area of Science:
- Gastroenterology
- Microbiology
- Immunology
Background:
- Clostridioides difficile infection (CDI) can lead to persistent functional gut symptoms resembling Post-Infectious Irritable Bowel Syndrome (PI-IBS) in up to 25% of patients.
- Current management for persistent symptoms after CDI involves a dilemma between further antibiotic use or conservative symptom management.
Purpose of the Study:
- To review the literature on CDI-related PI-IBS and compare it with general PI-IBS.
- To explore proposed mechanisms underlying CDI-related PI-IBS, including the roles of C. difficile toxins and gut microbiota dysbiosis.
- To discuss therapeutic implications, particularly microbiota-directed therapies for primary CDI.
Main Methods:
- Literature review of studies on CDI-related PI-IBS and PI-IBS.
- Analysis of proposed pathogenic mechanisms involving C. difficile toxins and gut microbiota.
- Discussion of current and potential therapeutic strategies.
Main Results:
- Gut dysfunction post-CDI may be initiated by toxin-induced damage to enteroglial cells.
- A dysbiotic gut microbiota is implicated in maintaining the chronic PI-IBS phenotype after CDI.
- Fecal Microbial Transplant (FMT) is currently used for recurrent CDI (rCDI) but its potential in primary CDI is explored.
Conclusions:
- Microbiota-directed therapies, including novel microbial transfer strategies, warrant consideration for primary CDI to prevent or mitigate PI-IBS.
- Preventing further antibiotic disruption of the microbiota may be key to avoiding long-term functional symptoms.
- Clinical trials are recommended to evaluate microbial transfer therapy for primary CDI to prevent both rCDI and CDI-related PI-IBS.
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