Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21^st century

Abstract

Irritable bowel syndrome (IBS) affects about 12% of the global population. Although IBS does not develop into a serious disease or increase mortality, it results in a considerable reduction in the quality of life. The etiology of IBS is not known, but the intestinal microbiota appears to play a pivotal role in its pathophysiology. There is no effective treatment for IBS, and so the applied treatments clinically focus on symptom relief. Fecal microbiota transplantation (FMT), an old Chinese treatment, has been applied to IBS patients in seven randomized controlled trials (RCTs). Positive effects on IBS symptoms in various degrees were obtained in four of these RCTs, while there was no effect in the remaining three. Across the seven RCTs there were marked differences in the selection processes for the donor and treated patients, the transplant dose, the route of administration, and the methods used to measure how the patients responded to FMT. The present frontier discusses these differences and proposes: (1) criteria for selecting an effective donor (superdonor); (2) selection criteria for patients that are suitable for FMT; (3) the optimal FMT dose; and (4) the route of transplant administration. FMT appears to be safe, with only mild, self-limiting side effects of abdominal pain, cramping, tenderness, diarrhea, and constipation. Although it is early to speculate about the mechanisms underlying the effects of FMT, the available data suggest that changes in the intestinal bacteria accompanied by changes in fermentation patterns and fermentation products (specifically short-chain fatty acids) play an important role in improving the IBS symptoms seen after FMT. FMT appears to be a promising treatment for IBS, but further studies are needed before it can be applied in everyday clinical practice.

Role of GDNF, GFRα1 and GFAP in a Bifidobacterium-Intervention Induced Mouse Model of Intestinal Neuronal Dysplasia

“…The recovery of the impaired colonic motility confirmed the positive influence of Bifidobacterium on colonic motility, which is consistent with our clinical experience. These results are also consistent with recent findings that fecal microbiota transplantation can improve intestinal function (33,34).…”

Studies on irritable bowel syndrome associated with anxiety or depression in the last 20 years: A bibliometric analysis

“…However, there were differences in the outcomes of randomized controlled trials (RCTs) of FMT in IBS as some RCTs showed no effect on FMT treatment ( 42 , 43 ). The contradictory results might be attributed to the factors including differences in the donor selection, differences in the patient selection, dose and frequency of FMT, and administration route ( 44 , 45 ).…”

Global research trends and hotspots of fecal microbiota transplantation: A bibliometric and visualization study

“…The current studies mainly focus on the follow two aspects. First, many randomized controlled trials (RCTs) are being conducted in recent years, positive effects in various degrees were obtained in some RCTs, while there was no effect in the others, so the results from these RCTs are inconsistent ( Zhao et al, 2020 ; El-Salhy et al, 2021 ). At the same time, almost all RCTs are small sample size studies ( Aroniadis et al, 2019 ; Costello et al, 2019 ; El-Salhy et al, 2020 ; Zhao et al, 2020 ).…”