CS-63
5/24/2016 9:15:00 AM - 5/24/2016 10:15:00 AM

BEYOND FMT: The Physiologic and Psychologic Sequelae of long term C. difficile infection

Having performed almost 200 Fecal Microbiota Transplant procedures at Mayo Clinic in Arizona we have documented and observed certain physiological and psychological phenomena in our patients post procedure. From a physiological standpoint we have observed common threads such as a post infectious colitis syndrome, fecal incontinence, potential food sensitivities and a change in their baseline bowel habits. The psychological impact of refractory Clostridum difficile has been revealed by our ongoing serial surveillance as well as our quality of life information gathered in our SF-12v2™ Health Survey. This project was started in Jan. 2015 and is ongoing at this time. The impact on our patients is profound and includes: anxiety, depression, shame, fear of going outside, fear of C. difficile recurrence, etc. It has certainly impacted the way we now educate our patients both pre FMT and for many months following their FMT procedure.

Objective / Content / Time Frame / Presenter / GI / Not GI
At the conclusion of this presentation, the participants will be able to:
1. Identify the physiologic components experienced by patients post Fecal Microbiota Transplant
2. List appropriate Interventions and monitoring of these components / I. Discuss common physiologic sequelae on patients in the post FMT recovery phase of six months
(>150 pts):
A. Post Infectious Colitis Syndrome and its components
B. Dietary Sensitivities
C. Stamina/Endurance recovery
D. Diarrhea/Constipation
E. Fecal Incontinence
II. Patient education
A. Discuss recovery process and variability
B. Use of bulking fibers
C. Appropriate use of anti-diarrheals
D. Exercise and sleep
E. Stool testing –typically no test for cure/symptoms
F. Fecal incontinence - Introduce Susan Sterler, RN / 20 Min / Cheryl Griesbach, RN
At the conclusion of this presentation, the participants will be able to:
1. Explain the pathophysiology of fecal incontinence
2. Identify patients with fecal incontinence in the pre FMT phase
3. List treatment options / Session Content 2:
I. Internal and external sphincter function
II. Thorough patient screening / FMT consult
a. Population identification and risk factors
b. Testing
III. Discuss diagnostic and treatment options:
a. Fiber supplements
b. Dietary modifications
c. Anal manometry, biofeedback/Kegel exercise / 15 min / Susan Sterler, RN
At the conclusion of this presentation, the participants will be able to:
1. Identify the psychological components of refractory C. difficile.
2. List various tools/ interventions for patients experiencing these components. / I. Discuss the various fears and anxieties
1. Fear of disease recurrence
2. Fear of exposing their family/friends/grandchildren
3. Fear of being incontinent in public
4. Waiting for the “shoe to drop”
5. Fear of using antimicrobials in the future
II. Education
1. Discuss relapse potential/success rates
2. Ongoing hygiene and home care
3. Discuss future antimicrobial use and risks
4. Assess patient need for further psychological intervention and referral. / 15 Min. / Cheryl Griesbach, RN
Total