Relief of irritable bowel syndrome by fecal microbiota transplantation is associated with changes in diversity and composition of the gut microbiota

Abstract

Objective To evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for refractory irritable bowel syndrome (IBS). Methods Microbiota suspensions from feces of the donors were injected into the intestines of 30 Chinese patients with refractory IBS. Microbiota composition analysis and genomic DNA extraction of fecal samples obtained from these patients at baseline and 1 month after FMT were performed. Clinical efficacy and safety of FMT were assessed using questionnaires covering four aspects of IBS therapeutic efficacy and assessment of adverse effects during a 6‐month follow‐up. Results FMT improved IBS gastrointestinal symptoms and alleviated depression and anxiety, as shown by the improved IBS‐QOL, IBS‐SSS, GSRS, HAMA and HAMD scores at 1 month and 3 months after FMT. A total adverse event rate of FMT was 6.7% (2/30). Gut microbiota analysis revealed that FMT responders had a significantly higher Shannon diversity index before FMT than non‐responders. In addition, analysis of differences in bacterial composition before and after FMT in responders showed specific abundance of the phyla Verrucomincrobia and Euryarchaeota at 1 month after FMT. At the genus level, Methanobrevibacter and Akkermansia were the most abundant fecal microbiota 1 month after FMT compared with those before FMT. Conclusions FMT may be an effective and safe therapeutic strategy for treating IBS that achieves a sustained clinical response 3‐6 months after the first procedure. Changes in the diversity and dominant flora may contribute to its therapeutic effect.

The Bacterium Akkermansia muciniphila: A Sentinel for Gut Permeability and Its Relevance to HIV-Related Inflammation

“…Huang et al reported that FMT improved gastrointestinal symptoms and alleviated depression and anxiety in irritable bowel syndrome (IBS) patients. Further, gut microbiota analyses revealed that Methanobrevibacter and A. muciniphila were the most abundant fecal microbiota a month after compared to before FMT (88).…”

Washed microbiota transplantation vs. manual fecal microbiota transplantation: clinical findings, animal studies and in vitro screening

“…An automatic preparation method for enriching microbiota from feces has been developed and is being used in serial FMT centers in China since 2014 (Cui et al, 2015;Cui et al, 2016;Qi et al, 2018;Wang et al, 2018;Ding et al, 2019;Huang et al, 2019). This method, originally designed on the concept of washed microbiota preparation is based on the automatic microfiltration machine (GenFMTer, Nanjing, China) and the following repeated centrifugation plus suspension with support from specific facilities.…”

Colonic transendoscopic tube-delivered enteral therapy (with video): a prospective study

“…Fecal microbiota transplantation (FMT) has shown the therapeutic potential in many microbiota-related diseases beyond Clostridium difficile infection (CDI) [1,2], such as inflammatory bowel disease (IBD) [3][4][5][6][7], serious antibiotics-associated diarrhea in intensive care unit [8], irritable bowel syndrome (IBS) [9,10], constipation [11], primary sclerosing cholangitis (PSC) [12] and immune checkpoint inhibitor-associated colitis [13]. Methods of FMT delivery are classified into three routes: the upper gut, the mid-gut and the lower gut [14,15].…”

“…Then, in order to meet the needs of patients with multiple fresh FMTs or whole colon administration of drugs during a period of time, we developed a colonic delivery method by the long-term maintenance of an indwelling, colonoscopically placed transanal enteral tube, which was coined colonic TET [14]. The technique of placing a tube through the anus into cecum for whole colon administration of FMTs or medications is therefore achieved, and it has been successfully used in many hospitals in Asia in recent 2 years [6,10,14,24,25].…”