Clinical response to fecal microbiota transplantation in patients with diarrhea-predominant irritable bowel syndrome is associated with normalization of fecal microbiota composition and short-chain fatty acid levels

Abstract

Irritable bowel syndrome (IBS) may be associated with disturbances in gut microbiota composition and functions. We recently performed a study of fecal microbiota transplantation (FMT) in diarrhea-predominant IBS (IBS-D) and found that IBS symptoms improved and the gut microbiota profile changed following FMT.We now aimed to explore the effects of FMT on the gut microenvironment in further detail by using 16S rRNA sequencing for more extended microbiota profiling and analyzing bacterial fermentation products (SCFAs: short chain fatty acids). Materials and methodsThe study included 13 patients (4 females and males) with IBS-D according to Rome III criteria and 13 healthy donors. Freshly donated feces were administered into duodenum via gastroscopy. The patients completed symptom and quality of life (QoL) questionnaires and delivered feces before and 1, 3, 12 and 20/28 weeks after FMT. Microbiota analysis was performed by sequencing 16S rRNA gene with Illumina Miseq technology. Fecal concentrations of SCFAs were analyzed by vacuum distillation followed by gas chromatography. ResultsSeveral gut microbiota taxa and SCFAs were significantly different in the patients at baseline compared to their donors. These differences normalized by the third week following FMT in parallel with significant improvement in symptoms and QoL.Responders had different gut microbiota profile and SCFAs than non-responders.Significant correlations were found between the gut microenvironment and IBS symptoms. No adverse effects were reported. ConclusionsFMT restores alterations of the gut microenvironment in IBS-D patients during the first 3 weeks and improves their symptoms for up to 28 weeks.

The propionic acid and butyric acid in serum but not in feces are increased in patients with diarrhea-predominant irritable bowel syndrome

“…It is reported that SCFAs might involve in regulating intestinal motility but those findings are not consistent. Recently, Mazzawi et al explored the effects of fecal microbiota transplantation on gut microenvironment and analyzed bacterial fermentation products in patients with IBS-D, and they confirmed the associations that both normal the levels of SCFAs and gut microbiota may be beneficial to IBS between gut microbiota, SCFAs and IBS symptoms [50].…”

Abnormal Uroguanylin Immunoreactive Cells Density in the Duodenum of Patients with Diarrhea-Predominant Irritable Bowel Syndrome Changes following Fecal Microbiota Transplantation

“…The total changes occurring to the gut microbiota profiles for the donors and the total group of IBS patients before and after FMT were previously described [26,28]. Briefly, several strains of the gut microbiota, namely, Ruminococcus gnavus, Clostridium sensu stricto, Actinobacteria, Bifidobacteria, and Gardnerella, for the donors were statistically significantly different from those for the patients before FMT, which normalized for the patients 3 weeks after FMT.…”

“…Previous publications have shown the effect of dietary changes on the symptoms [1,[13][14][15][16], gut microbiota [17,18], and enteroendocrine cells [19][20][21] in IBS patients. In addition, changing the composition of the gut microbiota through fecal microbiota transplantation (FMT) had a positive clinical outcome not only in cases of Clostridium difficile [22,23] but also in IBS [24][25][26][27][28]. The gut neuroendocrine system regulates all the functions of the gastrointestinal tract and consists of enteroendocrine cells and the enteric nervous system [29].…”

“…Newly published studies by our group [26,28] showed that using FMT in patients with diarrhea-predominant IBS (IBS-D) improved their symptoms and changed their gut microbiota profile. Using the same study cohort, the aims of this study were to determine whether there is abnormality in the density of uroguanylin immunoreactive cells in the duodenum of IBS patients compared to healthy controls (controls), to study the effect of changing the gut microbiota through FMT on the density of these cells, and to find the correlations between these cells and IBS symptoms (if any).…”

The propionic acid and butyric acid in serum but not in feces are increased in patients with diarrhea-predominant irritable bowel syndrome

“…It is reported that SCFAs might involve in regulating intestinal motility but those findings are not consistent. Recently, Mazzawi et al [51] explored the effects of fecal microbiota transplantation on gut microenvironment and analyzed bacterial fermentation products in patients with IBS-D, and they confirmed the associations that both normal the levels of SCFAs and gut microbiota may be beneficial to IBS between gut microbiota, SCFAs and IBS symptoms.…”