Fecal microbiota transplantation for the treatment of irritable bowel syndrome: A systematic review and meta-analysis

Abstract

BACKGROUND Irritable bowel syndrome (IBS) is the most prevalent gastrointestinal disorder in developed countries and reduces patients’ quality of life, hinders their ability to work, and increases health care costs. A growing number of trials have demonstrated an aberrant gut microbiota composition in IBS, also known as ‘gut dysbiosis’. Fecal microbiota transplantation (FMT) has been suggested as a treatment for IBS. AIM To assess the efficacy and safety of FMT for the treatment of IBS. METHODS We searched Cochrane Central, MEDLINE, EMBASE and Web of Science up to 24 October 2022 for randomised controlled trials (RCTs) investigating the effectiveness of FMT compared to placebo (including autologous FMT) in treating IBS. The primary outcome was the number of patients with improvements of symptoms measured using a validated, global IBS symptoms score. Secondary outcomes were changes in quality-of-life scores, non-serious and serious adverse events. Risk ratios (RR) and corresponding 95%CI were calculated for dichotomous outcomes, as were the mean differences (MD) and 95%CI for continuous outcomes. The Cochrane risk of bias tool was used to assess the quality of the trials. GRADE criteria were used to assess the overall quality of the evidence. RESULTS Eight RCTs (484 participants) were included in the review. FMT resulted in no significant benefit in IBS symptoms three months after treatment compared to placebo (RR 1.19, 95%CI: 0.68-2.10). Adverse events were reported in 97 participants in the FMT group and in 45 participants in the placebo group (RR 1.17, 95%CI: 0.63-2.15). One serious adverse event occurred in the FMT group and two in the placebo group (RR 0.42, 95%CI: 0.07-2.60). Endoscopic FMT delivery resulted in a significant improvement in symptoms, while capsules did not. FMT did not improve the quality of life of IBS patients but, instead, appeared to reduce it, albeit non significantly (MD -6.30, 95%CI: -13.39-0.79). The overall quality of the evidence was low due to moderate-high inconsistency, the small number of patients in the studies, and imprecision. CONCLUSION We found insufficient evidence to support or refute the use of FMT for IBS. Larger trials are needed.

The gut microbiome in disorders of gut–brain interaction

“…The same conclusions were also reached in another meta-analysis published in 2023 highlighting the overall low quality of evidence for FMT in IBS. 292 Repeated delivery of FMT to the small intestine appears to yield prolonged relief from symptoms and an enhancement in quality of life, as highlighted by a recent study. 293 While there appears to be a future for FMT in treating IBS, the specific mechanisms responsible for its effectiveness remain unclear.…”

Gut microbiota and intestinal immunity—A crosstalk in irritable bowel syndrome

“…In addition, few studies have explored the application of FMT in IBS concerning intestinal immunity. In general, the actual utility value of FMT still needs to be confirmed by larger and more comprehensively designed trials, in which the placebo effect, the source of FMT, the route of transplantation, the dose and frequency have been cited as confounders affecting the results of experiments that need to be emphasized [158, 159].…”

Recent advances in the treatment of functional dyspepsia and irritable bowel syndrome

“…drogi podania) przekraczających ramy tego artykułu. Wielu autorów zwraca uwagę na związany z heterogennością FMT problem z wyodrębnieniem badań do metaanalizy 42 .…”