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Fecal microbiota transplantation in irritable bowel syndrome: A meta-analysis of randomized controlled trials
Chatpol Samuthpongtorn1, Piyawat Kantagowit1, Rapat Pittayanon2
1Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Introduction:
Fecal microbiota transplantation (FMT) has been proposed as a potential treatment for irritable bowel syndrome (IBS); however, the consensus regarding its efficacy and safety is limited.
Materials And Methods:
We performed a systematic search of the literature using PubMed, EMBASE, Ovid MEDLINE, and Cochrane. Meta-analyses were conducted in relative risk (RR) or standard mean difference (SMD) using 95% confidence intervals (CI). Cochrane risk-of-bias 2 tool (RoB2) was employed to evaluate the study quality.
Result:
Of 2,589 potential records, 7 studies with 9 cohorts involving 505 participants were included. Meta-analyses showed no significant difference in the short-term (12 weeks) and long-term (12 months) global improvement of IBS symptoms of FMT vs. placebo (RR 0.63, 95% CI 0.39-1.00 and RR 0.88, 95% CI 0.53-1.45, respectively). There were statistically significant differences of short-term IBS-SSS improvement (SMD -0.58, 95% CI -1.09 to -0.88) and short-term IBS-QoL improvement (SMD 0.67, 95% CI 0.43-0.91). Eight from 9 studies (88.9%) had a low risk of bias. The subgroup analysis revealed the short-term global symptoms improvement in studies with low-risk of bias (RR 0.53, 95% CI 0.35-0.81), studies with well-defined donors (RR 0.31, 95% CI 0.14-0.72), and studies with FMT using colonoscopy (RR 0.66, 95% CI 0.47-0.92). Major FMT adverse events are transient and rapidly self-limiting.
Conclusion:
FMT significantly improved IBS-SSS and IBS-QoL in the short-term period in IBS patients. However, global symptom improvement showed no significance. Well-defined donors and appropriate fecal administration routes appear to be important factors for the successful outcomes of FMT in IBS.
Systematic Review Registration:
[www.crd.york.ac.uk/prospero], identifier [CRD42021246101].
Insights
Fecal microbiota transplantation (FMT) shows short-term benefits for irritable bowel syndrome (IBS) symptom scores and quality of life, but not overall global improvement. Donor quality and administration method are key for successful IBS treatment outcomes.
Area of Science:
- Gastroenterology
- Microbiome Research
- Clinical Therapeutics
Background:
- Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder with limited treatment options.
- Fecal microbiota transplantation (FMT) is being explored as a novel therapeutic strategy for IBS.
- Current evidence on FMT efficacy and safety in IBS requires systematic evaluation.
Approach:
- A systematic literature search was conducted across major databases (PubMed, EMBASE, Ovid MEDLINE, Cochrane).
- Meta-analyses were performed using relative risk (RR) or standard mean difference (SMD) with 95% confidence intervals (CI).
- Study quality was assessed using the Cochrane risk-of-bias 2 (RoB2) tool.
Key Points:
- Meta-analyses of 7 studies (9 cohorts, 505 participants) revealed no significant short-term or long-term global improvement in IBS symptoms with FMT versus placebo.
- FMT demonstrated statistically significant short-term improvements in IBS Severity Scoring System (IBS-SSS) and IBS Quality of Life (IBS-QoL) scores.
- Subgroup analyses indicated that short-term global symptom improvement was associated with low risk of bias, well-defined donors, and colonoscopic FMT administration.
Conclusions:
- Fecal microbiota transplantation offers significant short-term benefits for IBS symptom severity and quality of life.
- Overall global symptom improvement was not statistically significant in this meta-analysis.
- Optimizing donor characteristics and fecal delivery methods are crucial for enhancing FMT effectiveness in IBS management.
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