Post FMT Diarrhea

If you have had or are considering an FMT please share your experiences here.
ncg
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Post FMT Diarrhea

Postby ncg » Mon Jul 30, 2018 5:55 pm

My mother had an EGD based FMT procedure last week because Dificid was no longer working for C Diff. A few hours after, she started having severe diarrhea. The diarrhea was even more than with C Diff. I am wondering if this is normal and how long can it last? She was on Dificid up to 3 days before the procedure and I noticed the stools were more loose and more frequent which I expected since the C Diff was still there. She had about 15 BMs on Saturday and then I called the on-call GI Sunday morning who prescribed her Lomotil 4x day as needed. This did reduce the frequency to about 6 per day but when she does have a BM, it is still very watery. One thing I did notice is that her stool no longer "smells" like C Diff but more of a "normal" strong smelling stool. Perhaps, the FMT is working but concern is the diarrhea since she has congestive heart failure and kidney disease. We are giving her Pedialyte Advanced Care to make sure her electrolytes don't deplete. I don't want her to get dehydrated. We are also trying the BRAT diet (Bananas, Rice, Apple Sauce & Toast) to make it easier on her gut.

Wondering if anyone else has experienced this after a FMT and what we should do?

Thanks,
-N

roy
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Re: Post FMT Diarrhea

Postby roy » Mon Jul 30, 2018 7:03 pm

I would be very worried about the prescription for lomotil.
If she has c.diff slowing the gi tract is not recommended and can cause the toxin to stay in her gut.
cholestyramine might be an option, it binds the toxin and stops it causing damage. (it does not cure, it just stops the symptoms)
Was there a reason to choose the upper route for the FMT?
The vast majority and highest success rate are via colonoscopy.
If her symptoms dont resolve in a day or two or get worse she might need to go back onto c.diff meds.
What treatment has she had so far?

ncg
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Re: Post FMT Diarrhea

Postby ncg » Mon Jul 30, 2018 7:27 pm

Thanks for the quick response Roy. She did use Cholestramine powder but it didn't seem to help much and that is why the doctor used something stronger. Since she was having 15-20 BMs a day, we felt something was needed to slow things down and prevent dehydration, at least until the FMT had time to establish a good flora. The post FMT strategy is to continue taking Florastor 2 x a day and 1 packet of EnterGam once a day. I"m also giving her some Activia with live probiotics and Pedialyte Advanced Care which includes Prebiotics.

Regarding why we did the upper route vs colonoscopy, it is what the procedure that GIs do. They go about 2 feet into the small intestine and put donated stool there. They also said this was preferred since going colonoscopy way would require some prep the day before and since my mom is 70 yrs old, malnutrition, it would be tough on her.

This was her second occurrence over 3 months. The first time she had C Diff they gave her Flagyl and then Dificid (since Vanco was out of the question due to severe allergy) and it did clear up the C Diff via the 10 day Dificid course. This second time around, the C Diff was much worse. She was admitted to the ER and had blood in stool & severe cramping in addition to the horrid smell and diarrhea. They started her on Dificid which seemed to work for the first 3 days and then the C Diff came back. She was kept on for Dificid for about 14 days and then off for 3 days before the FMT was performed.

The problem with going back on C Diff meds is that that it has to be Dificid and that is extremely expensive which is not covered by insurance. It is about $1300 (originally $4K) per 10 day course. We actually paid for it the first time and then was able to get a specialty pharmacy discount for a co-pay of $10. I am not sure if we will be able to do that again. I pray that this FMT works and if need be, then we can do another FMT. I'll ask more questions about why it was done via EGD and not colonoscopy. Thanks for that pointer.

One thing I want to mention again is that horrible C Diff smell is no longer there, although the diarrhea is. The smell seems more "normal" of what stool would seem like and she is also no longer has any cramping. Her GI that performed the FMT said he is not so worried about the diarrhea as the FMT should make it better toward end of the week. He was concerned about the frequency and said Lomotil will help with that.

roy
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Re: Post FMT Diarrhea

Postby roy » Mon Jul 30, 2018 8:05 pm

Dont totally rule out vanco.
Oral vanco is poorly absorbed and probably would not cause the same allergic reaction (assuming previous experiance was IV vanco).
Vanco is a very important drug when dealing with c.diff and can be given by enema in very severe cases.
They moved onto FMT quickly so let's hope it works.
Her symptoms are improving so that's a good sign.
I still dont like the Drs advice re lomotil though so do some research.
If she still has active c.diff you want to know about it and not hold in the toxin or mask the symptoms while it multiplies.
Dehydration can be rectified with IV fluid, toxic megacolon is another matter.

beth22
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Re: Post FMT Diarrhea

Postby beth22 » Mon Jul 30, 2018 11:21 pm

I got D from Activia. Maybe you should hold off on dairy products until D slows down. I also had problems with Florastor. If she took it before with no issues, then that is probably not a factor.

georgina
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Re: Post FMT Diarrhea

Postby georgina » Mon Jul 30, 2018 11:37 pm

Me too , Activia or any kind of yogurt will send me straight to the bathroom .
Also , until the gut adjusts to the new flora you can have nasty symptoms , although your mothers symptoms are kinda' severe. If D doesn't subside i would consider taking her back to the doctor.

ncg
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Re: Post FMT Diarrhea

Postby ncg » Wed Aug 01, 2018 2:20 pm

Good advice about Activia. I stopped giving her all yogurt and that has significantly dropped her diarrhea. I want to make sure she takes it easy on her gut by following the BRAT (Banana, Rice, Applesauce, Toast) diet which seems to be working.

I’ve read some other posts about Kefir. Have you tried that instead of the Activia? I know it is also milk based and also yogurt like but wondering if it also has the bad diarrhea that you experienced with Activia?

-N

roy
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Re: Post FMT Diarrhea

Postby roy » Wed Aug 01, 2018 2:51 pm

FMT is the ultimate probiotic.
I would wait and see if it works and not add anything new.

ncg
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Re: Post FMT Diarrhea

Postby ncg » Thu Aug 02, 2018 10:10 am

Just to update, my mom's bms were less and more formed the previous 2 days but then last night & this morning, she was back to having more watery diarrhea. Trying to figure out if it was something she ate or if this is just the normal post FMT process. I did give her like 2 oz of Kefir which I think I may have over done it. Also, for taste.. she wanted a little butter on her white rice which I think also can contribute to the diarrhea. It's been a constant battle between giving her food that is good for her and what she likes.

I guess there is no purpose of this post.. just venting the frustration. Tomorrow will be one week since the FMT and I do not know what to make of it. She has so many issues and this diarrhea since c diff has been hurting her chances to get better with the other list of problems she as. I was hoping she could get better and we can focus on physical therapy to start making her stronger. Thanks again to all for their feedback.

beth22
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Re: Post FMT Diarrhea

Postby beth22 » Fri Aug 03, 2018 12:54 am

Kefir gave me D too. I asked my GI about it and he said that he gets an upset stomach from it too and he has not had c difficile. Some people do fine with it. I would not give it to her right now. Stick to what works for the time being and she got plenty of good flora with the FMT. If the Florastor did not bother her, then perhaps that would be the only one you could try. It is supposedly recommended for traveler's D, so maybe it would sit okay. Personally, I can't take it. I get horrendous gas, cramping and loose stools. I also got a rash the last time I tried it.


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