Background: Irritable bowel syndrome (IBS) has been associated with microbial dysbiosis. Aim: To investigate the efficacy of faecal microbiota transplantation (FMT) in the treatment of IBS. Methods: Forty-nine IBS patients were randomised to receive autologous or allogenic FMT via colonoscopy. The primary endpoint was a sustained, minimum of 50point, reduction in the IBS Symptom Severity Score. The secondary outcomes were levels of anxiety and depression, changes in quality of life, gut microbiota and faecal water content as assessed with validated questionnaires, intestinal microbiota composition and stool dry weight.Results: The primary endpoint was not achieved in either group. However, there was a transient reduction in the mean IBS Symptom Severity Score in the FMT group at 12 weeks after treatment as compared to baseline (P = 0.01). The groups did not differ in the number of patients achieving clinical response at 12 weeks. In the FMTtreated patients, microbial composition had changed to resemble that of the donor and the stool water content decreased significantly compared to baseline. The depression score decreased in patients with a reduction in IBS symptoms after FMT, but not in those placebo-treated patients who experienced a reduction in IBS symptoms. Conclusions: FMT provided only a transient relief of symptoms, although it induced a sustained alteration in the microbiota of IBS patients. Therefore, FMT delivered by a single infusion via colonoscopy cannot be recommended as a treatment for IBS in clinical practice. ClinicalTrials.Org, Trial registration number: NCT03561519.
Fecal microbiota transplantation (FMT) is effective in recurrent Clostridium difficile infection (rCDI). Knowledge of the safety and efficacy of FMT treatment in immune deficient patients is scarce. FMT has been suggested as a potential method for an increasing number of new indications besides rCDI. Among our FMT-treated rCDI patients, we reviewed those with major comorbidities: two human immunodeficiency virus patients, six haemodialysis patients, two kidney transplant patients, two liver transplant patients and a patient with chronic lymphatic leukaemia. We also reviewed those treated with FMT for indications other than rCDI: Salmonella carriage (two patients), trimethylaminuria (two patients), small intestinal bacterial overgrowth (SIBO; one patient), and lymphocytic colitis (one patient), as well as a common variable immunodeficiency patient with chronic norovirus infection and ESBL-producing Escherichia coli (E. coli) carriage. Of the thirteen rCDI patients treated with FMT, eleven cleared the CDI. The observed adverse events were not directly attributable to FMT. Concerning the special indications, both Salmonellas and ESBL-producing E. coli were eradicated. One trimethylaminuria patient and one SIBO-patient reported a reduction of symptoms. Three patients did not experience a benefit from FMT: chronic norovirus, lymphocytic colitis and the other fish malodour syndrome. There were no reported side effects in this group. FMT appeared to be safe and effective for immunocompromised patients with rCDI. FMT showed promise for the eradication of antibiotic-resistant bacteria, but further research is warranted.
Nutritional evaluation of a sailing crew during a transatlantic race. Scand J Med Sci Sports 1991: 1: 99-103.Few studies describe the nutritional status of people in stressful situations and with limited access to food. We assessed the dietary intake and serum indices of nutritional status in a sailing crew (n = 14) during a transatlantic race.and in a control group (n = 11 males). The crew's mean energy intake was 13.3 MJ/d. In both groups, the intake of retinol, thiamin, riboflavin, vitamin C, calcium and iron was sufficient but the intake of vitamin B,, magnesium and zinc rather low. In sailors, serum HDL cholesterol was higher before the race (1.61 mmol/l; 95% confidence interval: 1.441.69) than after it (1.34 mmol/l; 1.26-1.43). Serum calcium, potassium, magnesium, femtin, zinc, and selenium concentrations did not indicate nutritional deficiency in either group.Long sailing competitions (3-6 weeks) present some unique challenges. Food storage space on a sailboat is minimal and supplies cannot be replenished; therefore, most provisions must be stored dry. Competitive sailors operate under heavy mental and moderate physical strain; consequently, their diet must be adequate to keep them in peak performance condition. Those involved in space flights, submarine patrols, arctic expeditions, and military maneuvers confront similar situations.Not many published studies describe the nutritional status of people in stressful situations and with limited access to food. Lichton et al. (1) studied soldiers who consumed only ready-to-eat meal rations throughout a 34-d intensive training period. 8 Their weight decreased significantly during this time. The vitamin C, folate, retinol, vitamin B6 and zinc status indices suggested that they maintained, in general, an acceptable nutritional status. However, in an earlier report, Miyamura et al. (2) found that the zinc status in the same kind of situations might have been inadequate. In a study comprising submariners, Reynolds et al. (3) reported impaired vitamin B6 status during a prolonged patrol.In this study we assessed the intake of energy and nutrients in sailors during a transatlantic sailing competition. In addition, we examined whether any changes could be found in body weight or in selected indices of cholesterol, mineral and trace element status.
ImportanceSevere obesity is a major health concern. However, a few patients remain resistant to bariatric surgery and other treatments. Animal studies suggest that weight may be altered by fecal microbiota transplantation (FMT) from a lean donor.ObjectiveTo determine whether FMT from a lean donor reduces body weight and further improves the results of bariatric surgery.Design, Setting, and ParticipantsThis double-blinded, placebo-controlled, multicenter, randomized clinical trial was conducted in 2018 to 2021 among adult individuals with severe obesity treated at 2 bariatric surgery centers in Finland and included 18 months of follow-up. Patients eligible for bariatric surgery were recruited for the study. Data were analyzed from March 2021 to May 2022.InterventionsFMT from a lean donor or from the patient (autologous placebo) was administered by gastroscopy into the duodenum. Bariatric surgery was performed 6 months after the baseline intervention using laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG)Main Outcomes and MeasuresThe main outcome was weight reduction measured as the percentage of total weight loss (TWL).ResultsForty-one patients were recruited to participate in the study and were included in the final analysis (29 women [71.1%]; mean [SD] age, 48.7 [8.7] years; mean [SD] body mass index, 42.5 [6.0]). A total of 21 patients received FMT from a lean donor, and 20 received an autologous placebo. Six months after FMT, 34 patients underwent LRYGB and 4 underwent LSG. Thirty-four patients (82.9%) attended the last visit 18 months after the baseline visit. The percentage of TWL at 6 months was 4.8% (95% CI, 2.7% to 7.0%; P < .001) in the FMT group and 4.6% (95% CI, 1.5% to 7.6%; P = .006) in the placebo group, but no difference was observed between the groups. At 18 months from the baseline (ie, 12 months after surgery), the percentage of TWL was 25.3% (95% CI, 19.5 to 31.1; P < .001) in the FMT group and 25.2% (95% CI, 20.2 to 30.3; P < .001) in the placebo group; however, no difference was observed between the groups.Conclusions and RelevanceFMT did not affect presurgical and postsurgical weight loss. Further studies are needed to elucidate the possible role of FMT in obesity.Trial RegistrationClinicalTrials.gov Identifier: NCT03391817
LINKED CONTENTThis article is linked to Lahtinen et al and Ianiro et al papers. To view these articles, visit https://doi.org/10.1111/apt.15740 and https://doi.org/10.1111/apt.15923
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