The combined therapy of fecal microbiota transplantation and laxatives for functional constipation in adults

Abstract

Objective: Functional constipation is a prevalent, burdensome gastrointestinal disorder whose treatment remains challenging. Combined therapy uniting multiple treatments may be promising. Fecal microbiota transplantation (FMT) which tends to be an etiological treatment has been increasingly investigated in its management. Meanwhile, laxatives are widely used to relieve constipation temporarily, but their overall efficacy is poor. Therefore, we performed meta-analyses of randomized controlled trials to evaluate the joint efficacy of FMT and laxatives in functional constipation. Methods: We performed a systematic literature search of 6 electronic databases as of August 11, 2020. Randomized controlled trial of FMT together with laxatives vs laxatives alone in functional constipation in adults were included. Two reviewers independently performed the screening, data extraction, and bias assessment. Dichotomous outcome data were synthesized by risk ratio, and measurement data by weighted mean difference (WMD). Results: A total of 1400 records were identified, of which 5 were eligible (409 patients). Overall, compared to laxatives alone, combined therapy of FMT and laxatives more significantly improved total effective rate (risk ratio: 1.35; 95% confidence interval [CI]: 1.14, 1.60; I 2 = 13%), Bristol stool form scale score (WMD: 1.04; 95% CI: 0.57, 1.51; I 2 = 76%), reduce Wexner score (WMD: −3.25; 95% CI: −5.58, −0.92; I2 = 92%), Knowles-Eccersley-Scott-Symptom (KESS) score (WMD: −5.65; 95% CI: −7.62, −3.69; I 2 = 0%) and patient assessment of constipation quality of life score (WMD: −18.56; 95%; CI: −26.43, −10.68; I 2 = 78%). No serious adverse events were reported. The majority of included studies had poor methodological quality. Conclusion: Combined therapy of FMT and laxatives may be a reasonably effective and safe treatment for people with functional constipation. However, caution is needed with the interpretation of these data due to the small sample size, high heterogeneity, and low quality of the studies. Besides, we expect that more studies will be performed exploring the efficacy and safety of combined therapy for functional constipation.

Long‐term improvement in constipation‐related symptoms after Helicobacter pylori eradication therapy

“…Moreover, a recent meta‐analysis reported that probiotics which modify the gastrointestinal microbiota may improve whole gut transit time, stool frequency, and stool consistency 34 . Combined therapy comprising laxatives and fecal microbiota transplantation (FMT), where fecal material containing gut microbiota from a healthy individual is transplanted into a patient with a dysbiosis‐related disease or condition, 35 has been shown to be a reasonably effective and safe treatment for patients with functional constipation (risk ratio: 1.35; 95% CI: 1.14, 1.60; I2% = 13%) 36 . Therefore, it is possible that H .…”

“…34 Combined therapy comprising laxatives and fecal microbiota transplantation (FMT), where fecal material containing gut microbiota from a healthy individual is transplanted into a patient with a dysbiosis-related disease or condition, 35 has been shown to be a reasonably effective and safe treatment for patients with functional constipation (risk ratio: 1.35; 95% CI: 1.14, 1.60; I2% = 13%). 36 Therefore, it is possible that H. pylori infection and its eradication treatment affect the profile of the gut microbiota and contribute to the abnormality and severity of bowel habits and symptoms.…”

Fecal Microbiota Transplantation and Health Outcomes: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials

“…Considering the purpose of the present umbrella review, we selected those studies that included the largest number of RCTs. Ultimately, 7 meta-analyses met the eligibility criteria ( Hui et al., 2019 ; Ianiro et al., 2019 ; Caldeira et al., 2020 ; Proença et al., 2020 ; Tang et al., 2020 ; Dharmaratne et al., 2021 ; Fang et al., 2021 ). Figure 2 shows the flowchart of the literature search.…”

The clinical efficacy of faecal microbiota transplantation: An umbrella review of randomized controlled trials

“…We used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) assessment to evaluate the credibility of the evidence provided by each association in the meta-analysis 27, 28 . Evidence from the meta-analysis of randomized controlled trials was evaluated based on the significance of the pooled effect, using a p value of <0.05 as statistical significance.…”