Abstract
BackgroundRandomized controlled trials (RCTs) have examined the efficacy of fecal microbiota transplantation (FMT) in irritable bowel syndrome (IBS) with inconsistent results. We performed a meta-analysis to assess both the short- and long-term efficacy of FMT in IBS.MethodsMEDLINE, EMBASE, and the Cochrane Central Register were searched through September 2021. RCTs recruiting adult patients with IBS that compared FMT with placebo with dichotomous data of response to therapy were eligible. Dichotomous data were pooled to obtain a relative risk (RR) of symptom not improving after therapy. RR was also pooled for adverse events (AEs). Continuous data were calculated using a mean difference for IBS-Quality of Life (IBS-QoL). GRADE methodology was used to assess quality of evidence.ResultsThe search strategy generated 658 citations. Seven RCTs comprising 472 patients with IBS were included. FMT was not associated with a significant improvement in global symptom in IBS at 12 weeks in comparison with placebo (RR 0.75, 95% CI 0.43–1.31) with high heterogeneity between studies (I2 87%). Subgroup analyses showed that FMT was superior to placebo when administered via colonoscopy or gastroscope (RR 0.70, 95% CI 0.51–0.96; RR 0.37, 95% CI 0.14–0.99, respectively, while FMT was inferior to placebo when administered via oral capsules (RR 1.88, 95% CI 1.06–3.35). FMT induced a significant improvement in IBS-QoL compared to placebo (mean difference 9.39, 95% CI 3.86–14.91) at 12 weeks. No significant difference in the total number of AEs was observed between FMT and placebo (RR 1.20, 95% CI 0.59–2.47). FMT did not significantly improve global symptom in IBS at 1-year follow-up compared with placebo (RR 0.90, 95% CI 0.72–1.12). The GRADE quality evidence to support recommending FMT in IBS was very low.ConclusionIBS patients may benefit from FMT when administered via colonoscopy or gastroscope. FMT may improve the quality of life of IBS. The long-term use of FMT in IBS warrants further investigation. There is very-low-quality evidence to support recommending FMT in IBS.
Highlights
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a worldwide prevalence of 5%– 10% (Ford et al, 2020; Oka et al, 2020), characterized by recurrent abdominal pain in association with defecation (Camilleri, 2021)
The search strategy generated 658 citations, of which 56 citations were reviewed for full text after an initial screening of title and abstract. 49 studies were excluded for various reasons, leaving seven articles comprising seven Randomized controlled trials (RCTs) eligible in the meta-analysis (Figure 1) (Halkjaer et al, 2018; Johnsen et al, 2018; Aroniadis et al, 2019; Holster et al, 2019; El-Salhy et al, 2020; Lahtinen et al, 2020; Holvoet et al, 2021)
The subgroup analyses showed that IBS patients may benefit from fecal microbiota transplantation (FMT) when administered via colonoscopy or gastroscope, or when fresh donor stool was used
Summary
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a worldwide prevalence of 5%– 10% (Ford et al, 2020; Oka et al, 2020), characterized by recurrent abdominal pain in association with defecation (Camilleri, 2021). Alterations in gut microbiota in IBS patients compared to healthy controls have been well documented in various studies (Carroll et al, 2012; Tap et al, 2017; Pittayanon et al, 2019). IBS patients are more likely to be linked to small intestinal bacterial overgrowth compared to healthy individuals (Shah et al, 2020). Therapies targeting modulation of microbiota such as antibiotics, probiotics, and prebiotics have achieved promising effects in IBS patients (Ford et al, 2018). Randomized controlled trials (RCTs) have examined the efficacy of fecal microbiota transplantation (FMT) in irritable bowel syndrome (IBS) with inconsistent results. We performed a meta-analysis to assess both the short- and long-term efficacy of FMT in IBS
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