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Published on: April 6, 2022
Fecal Microbiota Transplantation for Symptom Improvement in Patients With Irritable Bowel Syndrome: Systematic Review
Natsuda Aumpan1, Jun Watanabe2, Yuhong Yuan3
1Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Chulabhorn International College of Medicine (CICM) at Thammasat University, Pathumthani, Thailand; Center of Excellence in Digestive Diseases and Gastroenterology Unit, Department of Medicine, Thammasat University, Pathumthani, Thailand.
Background & Aims:
Fecal microbiota transplantation (FMT) could improve symptoms of irritable bowel syndrome (IBS) in some previous trials. We updated a prior meta-analysis of randomized controlled trials (RCTs) determining this issue.
Methods:
We searched CENTRAL, MEDLINE, and Embase (via Ovid) from inception to February 20, 2026, to identify potential studies. We included RCTs that reported the proportion of patients with IBS symptom improvement assessed between 4 and 24 weeks after FMT. For primary outcome, we estimated risk ratios (RR) of proportion of patients with IBS symptoms not improved. Data were pooled using a random effects model. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation.
Results:
Thirteen RCTs involving 693 patients were eligible for this review. For the intention-to-treat analysis, FMT may reduce IBS symptoms at 12 weeks compared with placebo, but the evidence is very uncertain (RR of symptom not improved with FMT compared with placebo = 0.72; 95% confidence interval [CI], 0.50-1.03). However, in the per-protocol analysis, FMT was statistically significant at improving symptoms (RR, 0.67; 95% CI, 0.46-0.97). Overall adverse events were not different in both groups (RR, 0.98; 95% CI, 0.75-1.29). The subgroup analysis reported IBS symptom improvement using a single dose of FMT (RR, 0.62; 95% CI, 0.41-0.93), and when IBS was diagnosed by Rome IV criteria (RR, 0.38; 95% CI, 0.17-0.86).
Conclusions:
This systematic review suggested there was very low certainty of evidence that FMT improved IBS symptoms. FMT was effective in some subgroup analyses and in the overall per-protocol analysis, but this needs to be interpreted with caution. (Registration number: PROSPERO CRD420251086189.).
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