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Fecal microbiota transplantation for the treatment of irritable bowel syndrome: A systematic review and meta-analysis
Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
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2023 (English)In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 29, no 20, p. 3185-3202Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND; Irritable bowel syndrome (IBS) is the most prevalent gastrointestinal disorder in developed countries and reduces patients’ quality of life, hinders their ability to work, and increases health care costs. A growing number of trials have demonstrated an aberrant gut microbiota composition in IBS, also known as ‘gut dysbiosis’. Fecal microbiota transplantation (FMT) has been suggested as a treatment for IBS.

AIM: To assess the efficacy and safety of FMT for the treatment of IBS.

METHODS: We searched Cochrane Central, MEDLINE, EMBASE and Web of Science up to 24 October 2022 for randomised controlled trials (RCTs) investigating the effectiveness of FMT compared to placebo (including autologous FMT) in treating IBS. The primary outcome was the number of patients with improvements of symptoms measured using a validated, global IBS symptoms score. Secondary outcomes were changes in quality-of-life scores, non-serious and serious adverse events. Risk ratios (RR) and corresponding 95%CI were calculated for dichotomous outcomes, as were the mean differences (MD) and 95%CI for continuous outcomes. The Cochrane risk of bias tool was used to assess the quality of the trials. GRADE criteria were used to assess the overall quality of the evidence.

RESULTS: Eight RCTs (484 participants) were included in the review. FMT resulted in no significant benefit in IBS symptoms three months after treatment compared to placebo (RR 1.19, 95%CI: 0.68-2.10). Adverse events were reported in 97 participants in the FMT group and in 45 participants in the placebo group (RR 1.17, 95%CI: 0.63-2.15). One serious adverse event occurred in the FMT group and two in the placebo group (RR 0.42, 95%CI: 0.07-2.60). Endoscopic FMT delivery resulted in a significant improvement in symptoms, while capsules did not. FMT did not improve the quality of life of IBS patients but, instead, appeared to reduce it, albeit non significantly (MD -6.30, 95%CI: -13.39-0.79). The overall quality of the evidence was low due to moderate-high inconsistency, the small number of patients in the studies, and imprecision.

CONCLUSION: We found insufficient evidence to support or refute the use of FMT for IBS. Larger trials are needed

Place, publisher, year, edition, pages
Baishideng Publishing Group Inc. , 2023. Vol. 29, no 20, p. 3185-3202
Keywords [en]
Fecal microbiota transplantation, Irritable bowel syndrome, Meta-analysis, Systematic review
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-106103DOI: 10.3748/wjg.v29.i20.3185ISI: 001020560400010PubMedID: 31662860Scopus ID: 2-s2.0-85162853635OAI: oai:DiVA.org:oru-106103DiVA, id: diva2:1760060
Available from: 2023-05-29 Created: 2023-05-29 Last updated: 2024-02-27Bibliographically approved

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König, JuliaBrummer, Robert Jan

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