Xylitol Use for Decolonization of C. Difficile in Patients With IBD

This randomized placebo-controlled dose-finding trial will assess the safety and efficacy of xylitol as an oral therapeutic for decolonization of C. difficile in the IBD patient population.

Participants with confirmed IBD diagnosis who are scheduled for an outpatient colonoscopy for any reason at Brigham and Women's Hospital or clinic appointment at the Crohn's and Colitis Center will be eligible for screening. Participants will be screened for C. difficile colonization via colonic wash sampling during colonoscopy or whole stool following a clinic appointment.

Participants may only have inactive or mild IBD based in clinical scores (see inclusion criteria) to be eligible for screening. Risk factors for colonization will be assessed by comparing colonized vs. not colonized patients.

Participants who are found to be colonized will be randomized 1:1:1 to either placebo or one of two dosing groups of xylitol. The dose A treatment arm will receive 7.5 grams daily of xylitol via gel capsule for 4 weeks. The dose B treatment arm will receive 15 grams daily of xylitol via gel capsule for 4 weeks. The placebo arm will receive identical capsule dosing for 4 weeks. Participants will end dosing at week 4, but monitoring will continue through week 52. Both participants and study team will be blinded to treatment arm allocation.

The primary endpoints assessed are decolonization at week 8 as well as safety and tolerability through week 8. In addition, secondary efficacy outcomes including IBD disease activity and development of CDI, which will be evaluated at week 8, week 26 and week 52. Disease activity and symptoms will be recorded from informed consent through the week 52 trial visit.

Stool samples for biomarker assessments and C. difficile testing will be collected at scheduled trial visits per Schedule of Assessments.

Inclusion criteria

• Signed informed consent.
• Male or female ≥ 18 years of age
• IBD diagnosis (CD, UC or indeterminant Colitis will be permitted)
• Inactive or mild IBD (HBI score ≤ 7; Partial Mayo score ≤ 4)
• Presenting for outpatient colonoscopy or clinic appointment for any indication

Exclusion criteria

• Unable to provide consent
• Patients with previous colectomy, ostomy, J-pouch, or previous colon surgery (excluding appendectomy)
• Unable to complete study procedures
• Chronic use of antibiotics
• Inability or unwillingness to swallow capsules
• Allergy to xylitol
• Stool positive for Listeria monocytogenes