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Fecal microbiota transplant effective for irritable bowel syndrome
Clinical Question
Does a fecal microbiota transplant safely improve symptoms in patients with irritable bowel syndrome?
Bottom line
This is the largest and best study to date of fecal microbiota transplant (FMT) for irritable bowel syndrome (IBS)—with impressive results. The authors argue that the quality of donor stool is an important factor and may explain the differences in results (one previous study had positive findings, the other did not). Although findings persisted and even improved between 1 and 3 months post-transplant, it is unclear how long the benefits will persist. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Foundation
Setting: Outpatient (specialty)
Synopsis
When we call something a "syndrome" that often means we don't know what causes it or how to treat it. But it seems like all those bacteria in the gut may have something to do with IBS. These authors identified 200 Norwegian patients who met the Rome IV criteria for IBS who had no red flags for inflammatory bowel disease or malignancy. They had all failed a 12-week course of dietery manipulation therapy. At baseline, a stool sample was taken. After excluding 35 patients, largely because of withdrawal or consent or declining participation, the authors randomized the remaining 165 patients to 1 of 3 groups: placebo (transplant with 30 grams of their own stool), 30-gram FMT, or 60-gram FMT. The FMTs were administered via upper endoscopy. The average age of participants was 40 years, 81% were women, and most had constipation or diarrhea-predominant IBS rather than mixed. The donor was a single healthy, nonsmoking male who had only received 3 courses of antibiotics in his life and ate a healthy diet. It's tempting to call him a superpooper, but the authors call him the "superdonor." A variety of IBS-specific scores were measured, and a response was defined as a reduction in the IBS Severity Scoring System score of at least 50 points at 3 months' follow-up. This occurred in 24% of the patients who received placebo, 77% who received the 30-gram FMT, and 89% who received the 60-gram FMT. These differences were both statistically and clinically significant, with a number needed to treat of 2 for one person to benefit. The benefit was similar for subgroups by type of IBS, by sex, and by duration of IBS symptoms. Patients reported improvements in quality of life, fatigue, and abdominal symptoms using validated survey instruments. The authors also analyzed the stool specimens after treatment and saw significant differences in some species, for what it's worth.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA