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

Abstract

Background:Gut microbiota has been identified as an imbalance in patients with irritable bowel syndrome (IBS). Fecal microbiota transplantation (FMT) is a novel method to restore microbiota and treat IBS patients.ObjectiveTo conduct a meta-analysis and estimate the efficacy and safety of FMT for the treatment of IBS patients with subgroup analyses to explore the most effective way of FMT for IBS.MethodsAll eligible studies were searched from PubMed, Embase, Web of Science, and the Cochrane Library through multiple search strategies. Data were extracted from studies comprising the following criteria: double-blind, randomized controlled trials (RCTs) that compared the efficacy of FMT with placebo for adult patients (≥18 years old) with IBS. A meta-analysis was performed to evaluate the summary relative risk (RR) and 95% confidence intervals (CIs).ResultsA total of seven RCTs comprising 489 subjects were eligible for this meta-analysis. Pooled data showed no significant improvement of global IBS symptoms in patients with FMT compared with placebo (RR = 1.34; 95% CI 0.75–2.41, p = 0.32). A significant heterogeneity was observed among the studies (I2 = 83%, p < 0.00001). There was no significant evidence of funnel plot asymmetry (Egger's test, p = 0.719; Begg's test, p = 1.000), indicating no existence of publication bias. Subgroup analyses revealed that FMT operated by invasive routes, including gastroscope, colonoscope, and nasojejunal tube, significantly improved global IBS symptoms (RR = 1.96; 95% CI 1.23–3.11, p = 0.004) with heterogeneity (I2 = 57%, p = 0.06) and an NNT of 3 (95% CI 2–14). However, FMT delivered via oral capsules showed a negative impact on patients with IBS (RR = 0.56; 95% CI 0.33–0.96, p = 0.03) with a low heterogeneity (I2 = 39%, p = 0.2) and an NNH of 3 (95% CI 2–37).ConclusionThe current evidence from RCTs with all routes of FMT does not show significant global improvement in patients with IBS. However, FMT operated by invasive routes significantly improved global IBS symptoms.

Microbiome‐modulating nutraceuticals ameliorate dyslipidemia in type 2 diabetes: A systematic review, meta‐analysis, and meta‐regression of clinical trials

“…With the growing interest and research in the field of gut microbiome and its link to various diseases, there is also an emergent need to provide practical applications for this gained knowledge and use it to successfully implement targeted modulations with dedicated benefits for human hosts. 19 Although empirical modulation of the microbiome for its therapeutic potential has been performed for over millennia, most popularly via the use of traditional herbal medicine and most recently via faecal microbiota transplantation, [90][91][92] the subject has gained scientific traction in recent years following the continual discovery of bridges linking the gut to various pathophysiological axes. [93][94][95][96][97][98][99][100][101][102][103][104][105] More specifically, with an increasing library of literature investigating the gut microbiome modulation in various metabolic diseases, 39 including diabetes, 28 there is a need for high-quality quantitative syntheses to summarise clinical trials and provide direction for future research in this field by identifying strengths and limitations of available literature.…”

Fecal microbiota transplantation in irritable bowel syndrome: A meta-analysis of randomized controlled trials

“…This systematic review and meta-analysis evaluated the efficacy of FMT in the treatment of IBS and conducted subgroup analyses to determine the factors that influence the efficacy of FMT in IBS. Recently, the meta-analyses of RCTs regarding FMT and IBS were published in the year 2022 ( 23 , 24 ). Consistent with these meta-analyses, we found that FMT does not result in a significant global improvement in IBS patients, but that FMT performed via colonoscopy significantly improved global IBS symptoms.…”

“…The important factors including route of administration, characteristics of stool donors, donor microbiome profile, and patient microbiome profile influence the efficacy of FMT in IBS ( 17 , 18 , 22 ). Recent meta-analyses of RCTs on the efficacy of FMT in IBS have been published ( 23 , 24 ). These meta-analyses demonstrated that FMT does not result in a significant global improvement in IBS patients, but that FMT performed via invasive routes significantly improved global IBS symptoms.…”

Fecal microbiota transplantation in patients with post-infectious irritable bowel syndrome: A randomized, clinical trial

“…Notably, the results of the aforementioned studies were combined in a meta-analysis. So, in 4 ( 33 ), 5 RCT ( 34 ) and 7 ( 35 , 36 ) meta-analyses established that FMT doesn’t improve overall IBS symptoms in comparison with placebo. Conversely, a different meta-analysis assessed data from single-arm trials (SATs) and RCTs separately.…”

“…In contrast to the previous meta-analysis, 2 recent ones published in 2022 similarly do not show significant global improvement in patients with IBS. Nonetheless, FMT operated by invasive routes via colonoscopy or gastroscope significantly improved global IBS symptoms ( 35 , 36 ).…”