Efficacy of Fecal Microbiota Transplantation in Irritable Bowel Syndrome Patients

Abstract

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disease characterized by abdominal discomfort and bloating, diarrhea, and/or constipation. Fecal microbiota transplantation (FMT) is transferring the fecal bacteria and other microorganisms from a healthy person to another. We performed this systematic review and meta-analysis to assess the efficacy of FMT in treating IBS patients. We searched Scopus, PubMed, Cochrane, and Web of Science databases through June 2021 using relevant key words. We included 19 studies. Fecal microbiota transplantation was significantly superior to placebo in IBS quality of life after 4 weeks (mean difference [MD] = 7.47, 95% confidence interval [CI]: 2.05–12.89, p = .04), 12 weeks (MD = 9.99, 95% CI: 5.78–14.19, p < .00001), and 24 weeks (MD = 8.49, 95% CI: 0.47–16.52, p = .04), with no difference regarding IBS improvement symptoms and the IBS Severity Scoring System (SSS). Single-arm analysis revealed that the incidence of improvement of IBS symptoms was 57.8% (45.6%–69.9%) with reduction in IBS-SSS (MD = −74, 95% CI: −101.7 to −46.3). Fecal microbiota transplantation was superior to placebo in improving quality of life after 4, 12, and 24 weeks. Also, FMT improved IBS symptoms and reduced the IBS-SSS score. However, no deference was detected between FMT and placebo in IBS-SSS score and IBS symptoms improvement.

The gut microbiome dysbiosis and regulation by fecal microbiota transplantation: umbrella review

“…The response rate was 33.7% for nonoral placebo vs. 67.8% for capsule treatment (Xu et al, 2019). FMT vs. control was associated with a significantly higher IBS Quality of Life score at 4, 8, 12, and 24 weeks but no difference in IBS Severity Scoring System score (Myneedu et al, 2019;Elhusein and Fadlalmola, 2022).…”

“…Fresh or frozen donor stool administered via colonoscopy or nasojejunal tube all achieved significant improvements (Ianiro et al, 2019;Xu et al, 2019). However, FMT vs. placebo did not significantly improve IBS symptoms at 12 weeks (RR, 1.19; 95% CI, 0.67-2.13; low; Figure 8; Xu et al, 2019;Elhusein and Fadlalmola, 2022). Furthermore, single FMT via colonoscopy or nasojejunal tube vs. autologous FMT or placebo was associated with improvement (RR, 1.59; 95% CI, 1.06-2.39; low), whereas FMT with multiple-dose capsules vs. capsule excipients as placebo was associated with a lower likelihood of global improvement (RR, 0.54; 95% CI, 0.34-0.85; low; Figure 8; Xu et al, 2019).…”

“…Among patients with IBS, 57.8% (95% CI, 45.6-69.9%; very low) showed significant improvement (Figure 7; Xu et al, 2019;Elhusein and Fadlalmola, 2022). Fresh or frozen donor stool administered via colonoscopy or nasojejunal tube all achieved significant improvements (Ianiro et al, 2019;Xu et al, 2019).…”

Procedures in Fecal Microbiota Transplantation for Treating Irritable Bowel Syndrome: Systematic Review and Meta-Analysis

“…However, it remains unclear whether FMT efficacy extends to other gastrointestinal disorders such as IBS. To our best knowledge, eight systematic reviews with meta-analysis have been conducted for evaluating the efficacy of FMT on IBS treatment up-to-now [16][17][18][19][20][21][22][23], four of them in 2022. This number shows the clinical relevance of IBS as well as FMT as therapy.…”

Fecal microbiota transplantation for irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials

“…So far, some meta-analyses have evaluated the efficacy of FMT in the treatment of IBS, and they unanimously concluded that FMT is ineffective for IBS ( 17 – 19 ). Unfortunately, some recently published RCTs ( 20 – 22 ) were not included in these analyses, so the conclusions may not represent the real results very well.…”