Efficacy and safety of fecal microbiota transplant in irritable bowel syndrome: An update based on meta‐analysis of randomized control trials

Abstract

Background and Aims Fecal microbiota transfer (FMT) is a potential treatment for irritable bowel syndrome (IBS). Several randomized trials have tested FMT effects using different routes of administration, doses, and sample sizes. We aim to assess the overall efficacy of FMT for IBS patients and the safety of the intervention. Methods We systematically searched four databases for randomized control trials that studied the efficacy and safety of FMT in IBS patients. Results We included 8 randomized trials (472 patients) that compared FMT with placebo in IBS patients. Pooled results showed no statistically significant difference between FMT and control groups in the overall change in IBS symptom severity (IBS‐SSS) at 1 month ( p = 0.94), 3/4 months ( p = 0.82), and at the end of trials ( p = 0.67). No significant difference in the total number of respondents between the FMT and control groups (risk ratios = 1.84, [95% confidence interval (CI) = 0.82–2.65], p = 0.19). Although the oral route of administration showed a significant difference in the number of respondents ( p = 0.004), there was no statistically significant difference in the IBS‐SSS when subgrouping the oral route of administration (mean difference = 47.57, [95% CI = −8.74–103.87], p = 0.10). Conclusion FMT is not an effective treatment to relieve all the symptoms of IBS. Even in the groups that showed relatively significant improvement after FMT, the effect was proven to wear off over time and the re‐administration carries a low success rate. Future research should consider different bacterial‐based interventions such as probiotics or specific antibiotics.

The Gut Microbial Bile Acid Modulation and Its Relevance to Digestive Health and Diseases

“…Fecal microbiota transplantation for ailments other than recurrent Clostridium difficile infections after antibiotic treatment have been disappointing and plagued with inconsistent results. 206 – 210 Probiotics have not done better with inconsistent results between studies, despite a strong publication bias. 211 , 212 This is likely because live bacterial products have difficulty surviving in the luminal environment.…”

Efficacy and safety of fecal microbiota transplantation for the treatment of irritable bowel syndrome: an overview of overlapping systematic reviews

“…Following that, 116 records were excluded based on their titles and abstracts, and 8 records were excluded owing to inconsistency with inclusion criteria. Finally, we included seven SRs in this overview ( Ianiro et al, 2019 ; Xu et al, 2019 ; Abdelghafar et al, 2022 ; Samuthpongtorn et al, 2022 ; Wu et al, 2022 ; Zhao et al, 2022 ; Rodrigues et al, 2023 ). Figure 1 presents the PRISMA flow diagram.…”

“…As assessed by three SRs/MAs, one review reported that FMT significantly improved IBS-SSS compared to placebo ( Samuthpongtorn et al, 2022 ), while the other two reviews indicated no statistical difference between the two treatments ( Abdelghafar et al, 2022 ; Zhao et al, 2022 ). As assessed by four SRs/MAs, three reviews reported that FMT significantly improved QoL compared to placebo ( Abdelghafar et al, 2022 ; Samuthpongtorn et al, 2022 ; Wu et al, 2022 ), while the other review indicated no statistical difference between the two treatments ( Zhao et al, 2022 ). The rate of adverse events was assessed by five SRs/MAs, and their results consistently indicated no statistical difference between the FMT group and the placebo group ( Ianiro et al, 2019 ; Xu et al, 2019 ; Abdelghafar et al, 2022 ; Wu et al, 2022 ; Rodrigues et al, 2023 ).…”

“…As assessed by four SRs/MAs, three reviews reported that FMT significantly improved QoL compared to placebo ( Abdelghafar et al, 2022 ; Samuthpongtorn et al, 2022 ; Wu et al, 2022 ), while the other review indicated no statistical difference between the two treatments ( Zhao et al, 2022 ). The rate of adverse events was assessed by five SRs/MAs, and their results consistently indicated no statistical difference between the FMT group and the placebo group ( Ianiro et al, 2019 ; Xu et al, 2019 ; Abdelghafar et al, 2022 ; Wu et al, 2022 ; Rodrigues et al, 2023 ).…”

“…Fecal microbiota transplantation (FMT) is a novel therapy for targeted balancing of intestinal microecological dysregulation that has been recognized as a successful treatment for recurrent Clostridium difficile infections ( Quraishi et al, 2017 ). Given the role of the intestinal microbiota in the etiology of IBS, interest in using FMT to treat IBS continues to increase, as does the number of systematic reviews (SRs) and meta-analyses (MAs) on this topic ( Ianiro et al, 2019 ; Xu et al, 2019 ; Abdelghafar et al, 2022 ; Samuthpongtorn et al, 2022 ; Wu et al, 2022 ; Zhao et al, 2022 ; Rodrigues et al, 2023 ).…”