Dynamic changes of intestinal flora in patients with irritable bowel syndrome combined with anxiety and depression after oral administration of enterobacteria capsules

Abstract

This study investigated the clinical characteristics and dynamic changes of intestinal bacterial community to evaluate the curative effect of fecal microbiota transplantation (FMT) on irritable bowel syndrome with predominant diarrhea (IBS-D) comorbid with anxiety and depression. Total two treatments were designed in randomize-controlled trial includes oral FMT capsules with 1 week (A1), 8 weeks (A2), and 12 weeks (A3), as well as oral empty capsules with 1 week (B1), 8 weeks (B2), and 12 weeks (B3) as control for comparison. The positive therapeutic effects occurred in FMT colonized patient with IBS-D comorbid psychological disorder, demonstrated at alleviated IBS-D severity (IBS-SSS score from 291.11 reduced to 144.44), altered stool type (from 6 changed to 4), reduced anxiety and depression scores (from 18.33 to 8.39 and from 22.33 to 17.78) after FMT-treated 12 weeks. The FMT therapy improved bacterial alpha diversity and the majority bacterial community predominant by Bacteroidetes and Firmicutes , and the relative abundance (RA) was higher after FMT-treated 12 weeks (50.61% and 45.52%) than control (47.62% and 38.96%). In short, FMT therapy has great potential for IBS-D patients combined with anxiety and depression by alleviated clinical symptoms and restore the intestinal micro-ecology.

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

“…Studies had found that alterations in gut microbiota composition existed in patients with either IBS, depression, or anxiety, alone or comorbid ( 33 ), and FMT could not only improve gastrointestinal symptoms but also show meaningful benefits in relieving anxiety and depression. Most scholars believed that the multiple effects of FMT on IBS patients with anxiety or depression should be attributed to the changes in the diversity and composition of the gut microbiota ( 34 – 36 ). Studies reported that the relative abundance of intestinal flora was higher after FMT ( 36 ), beneficial bacteria such as Bacteroidetes, Firmicutes, Verrucomincrobia, and Euryarchaeota were improved ( 36 , 37 ), and abundance of Faecalibacterium, Eubacterium, Escherichia, Enterobacteriaceae, Bacteroides, and Escherichia–Shigella was decreased ( 35 , 36 ).…”

“…Most scholars believed that the multiple effects of FMT on IBS patients with anxiety or depression should be attributed to the changes in the diversity and composition of the gut microbiota ( 34 – 36 ). Studies reported that the relative abundance of intestinal flora was higher after FMT ( 36 ), beneficial bacteria such as Bacteroidetes, Firmicutes, Verrucomincrobia, and Euryarchaeota were improved ( 36 , 37 ), and abundance of Faecalibacterium, Eubacterium, Escherichia, Enterobacteriaceae, Bacteroides, and Escherichia–Shigella was decreased ( 35 , 36 ). Moreover, an open-label observational study reported psychiatric symptom change during FMT in adult patients with IBS.…”

Fecal Microbiota Transplantation for Patients With Irritable Bowel Syndrome: A Meta-Analysis of Randomized Controlled Trials

“…( 20 ). Guo et al's study, which was excluded from our meta-analysis for the lack of the standard of global improvement, also reported altered gut microbiota in IBS patients treated with oral FMT ( 27 ). Enriched α- and β- bacterial diversity, increased concentrations of the beneficial Bacteroidetes and Firmicutes, as well as decreased toxic releaser Enterobacteriaceae, Bacteroides , and Escherichia coli Shigella were detected ( 27 ), which was partly similar with the result of El-Salhy et al's study ( 20 ).…”

“…Guo et al's study, which was excluded from our meta-analysis for the lack of the standard of global improvement, also reported altered gut microbiota in IBS patients treated with oral FMT ( 27 ). Enriched α- and β- bacterial diversity, increased concentrations of the beneficial Bacteroidetes and Firmicutes, as well as decreased toxic releaser Enterobacteriaceae, Bacteroides , and Escherichia coli Shigella were detected ( 27 ), which was partly similar with the result of El-Salhy et al's study ( 20 ). In El-Salhy et al's further study, they detected an increased fecal butyric acid level in the responders to FMT, which could be explained by the above changes in microbiota, indicating that changes in fecal short-chain fatty acids (SCFAs) may be a potential mechanism by which FMT could treat IBS ( 28 ).…”

Fecal microbiota transplantation in non-communicable diseases: Recent advances and protocols

“…Therefore, the increased bioavailability of these two key neurotransmitters that are heavily implicated in mood disorders, may be a mechanism by which FMT exerts beneficial effects. Additionally, FMT administration to individuals with irritable bowel syndrome (IBS) not only alleviated IBS symptoms but also significantly reduced both depression and anxiety scores ( 68 ). Similarly, in the case study reported by Xie et al ( 51 ) and discussed above, the patient with T1DM who underwent FMT treatment also had comorbid depression and treated with duloxetine.…”