Systematic review with meta‐analysis: efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome

Abstract

Summary Background Increasing evidence supports the role of the gut microbiota in the aetiology of irritable bowel syndrome (IBS). Faecal microbiota transplantation (FMT) is a highly effective treatment against recurrent Clostridioides difficile infection in randomised controlled trials (RCTs), and may be beneficial in ulcerative colitis. However, its efficacy in IBS is uncertain. Aim To perform a systematic review and meta‐analysis to examine this issue. Methods We searched MEDLINE, EMBASE, EMBASE Classic, the Cochrane Central Register of Controlled Trials, and clinicaltrials.gov through to March 2019. RCTs recruiting adults with IBS, which compared FMT with placebo, were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% CI. Results The search strategy identified 322 citations. Five RCTs were eligible for inclusion, containing 267 patients. Overall, 92.2% of included patients had IBS‐D or IBS‐M, and only 7.8% IBS‐C. When data were pooled for all patients, irrespective of stool type, the RR of IBS symptoms not improving was 0.98 (95% CI 0.58‐1.66). Placebo capsules administered orally were superior to capsules containing donor stool in two pooled trials (RR = 1.96; 95% CI 1.19‐3.20). FMT from donor stool delivered via colonoscopy was superior to autologous stool in two pooled RCTs (RR = 0.63; 95% CI 0.43‐0.93). FMT from donor stool via nasojejunal tube showed a trend towards a benefit over autologous stool in one trial (RR = 0.69; 95% CI 0.46‐1.02). Conclusions Fresh or frozen donor stool delivered via colonoscopy or nasojejunal tube may be beneficial in IBS. Larger, more rigorously conducted trials of FMT in IBS are needed.

Letter: balancing gut hydrogen as a proxy for bacteriotherapy benefits in irritable bowel syndrome

“…After a thorough search of published studies investigating the association between H pylori eradication and oesophageal adenocarcinoma incidence in PubMed, Embase and Web of Science database, only three related studies were identified including that by Kumar et al (Table 1). 1,7,8 Overall, the incidence of oesophageal adenocarcinoma after H pylori eradication was 0.01%-0.07% and there was no significantly increased risk of oesophageal adenocarcinoma following eradication. Perhaps the initial belief that H pylori protected against oesophageal adenocarcinoma through gastric acidity impairment seems to be a bias and is rather unlikely.…”

Demystifying the manipulation of host immunity, metabolism, and extraintestinal tumors by the gut microbiome

“…Fecal microbiota transplantation FMT is defined as the transmission of the gut microbiome derived from healthy donors to unhealthy recipients through the digestive tract route, which aims to reestablish gut homeostasis or to provide a new balance in order to abrogate or ameliorate 482 FMT has been recognized as a standard treatment for recurrent CDI by official guidelines with a nearly 90% cure rate. 482,483 Researchers are also increasingly realizing the potential of FMT in other noncancerous diseases, such as IBD, [484][485][486] IBS, 487 liver disease, 488 and neuropsychiatric disorders. 489 Hence, knowledge obtained from FMT in these diseases is also emerging evidence to indicate that FMT can be potentially employed in the management of cancer.…”

Proton pump inhibitor in upper gastrointestinal fecal microbiota transplant: A systematic review and analysis

“…Numerous studies have confirmed its efficacy and superiority to antibiotics in recurrent CDI. New research suggests that because of its effect on the microbiome, it may even have a role in other systemic diseases including inflammatory bowel disease, irritable bowel syndrome, and hepatic encephalopathy . As a relatively new option, FMT use remains limited to primarily academic centers and protocols are often facility dependent .…”