Systematic review with meta-analysis: efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome

Published on May 28, 2019in Alimentary Pharmacology & Therapeutics7.515
· DOI :10.1111/APT.15330
Gianluca Ianiro36
Estimated H-index: 36
(UCSC: Catholic University of the Sacred Heart),
Leonardo Henry Eusebi25
Estimated H-index: 25
(UNIBO: University of Bologna)
+ 3 AuthorsAlexander C. Ford86
Estimated H-index: 86
(University of Leeds)
BACKGROUND: Increasing evidence supports the role of the gut microbiota in the aetiology of irritable bowel syndrome (IBS). Faecal microbiota transplantation (FMT) is a highly effective treatment against recurrent Clostridioides difficile infection in randomised controlled trials (RCTs), and may be beneficial in ulcerative colitis. However, its efficacy in IBS is uncertain. AIM: To perform a systematic review and meta-analysis to examine this issue. METHODS: We searched MEDLINE, EMBASE, EMBASE Classic, the Cochrane Central Register of Controlled Trials, and through to March 2019. RCTs recruiting adults with IBS, which compared FMT with placebo, were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% CI. RESULTS: The search strategy identified 322 citations. Five RCTs were eligible for inclusion, containing 267 patients. Overall, 92.2% of included patients had IBS-D or IBS-M, and only 7.8% IBS-C. When data were pooled for all patients, irrespective of stool type, the RR of IBS symptoms not improving was 0.98 (95% CI 0.58-1.66). Placebo capsules administered orally were superior to capsules containing donor stool in two pooled trials (RR = 1.96; 95% CI 1.19-3.20). FMT from donor stool delivered via colonoscopy was superior to autologous stool in two pooled RCTs (RR = 0.63; 95% CI 0.43-0.93). FMT from donor stool via nasojejunal tube showed a trend towards a benefit over autologous stool in one trial (RR = 0.69; 95% CI 0.46-1.02). CONCLUSIONS: Fresh or frozen donor stool delivered via colonoscopy or nasojejunal tube may be beneficial in IBS. Larger, more rigorously conducted trials of FMT in IBS are needed.
📖 Papers frequently viewed together
2,373 Citations
540 Citations
133 Citations
#1Christopher J Black (University of Leeds)H-Index: 13
#2Nicholas E Burr (University of Leeds)H-Index: 14
Last. Alexander C. Ford (University of Leeds)H-Index: 86
view all 8 authors...
Objective Over half of patients with IBS have either diarrhoea (IBS-D) or a mixed stool pattern (IBS-M). The relative efficacy of licenced pharmacological therapies is unclear in the absence of head-to-head trials. We conducted a network meta-analysis to resolve this uncertainty. Design We searched MEDLINE, Embase, Embase Classic, the Cochrane central register of controlled trials, and through January 2019 to identify randomised controlled trials (RCTs) assessing the efficacy ...
49 CitationsSource
#1Dabo Xu (UM: University of Michigan)H-Index: 5
#2Vincent L. Chen (UM: University of Michigan)H-Index: 14
Last. Chung Owyang (UM: University of Michigan)H-Index: 70
view all 8 authors...
OBJECTIVES:Irritable bowel syndrome (IBS) is a common gastrointestinal condition with a heterogeneous pathophysiology. An altered gut microbiome has been identified in some IBS patients, and fecal microbiota transplantation (FMT) has been suggested to treat IBS. We performed meta-analyses and system
54 CitationsSource
#1Savanne Holster (Örebro University)H-Index: 4
#2Carl Mårten Lindqvist (Örebro University)H-Index: 9
Last. Robert-Jan M. Brummer (Örebro University)H-Index: 60
view all 7 authors...
OBJECTIVES: Fecal microbiota transfer (FMT) is suggested as a potential treatment for patients with irritable bowel syndrome (IBS). We aimed to study the effect of allogenic and autologous FMT on IBS symptoms, visceral sensitivity, and compositional changes in fecal and mucosa-adherent microbiota. METHODS: Seventeen patients with IBS were randomized either to receive fecal material from a healthy donor (allogenic) or to receive their own fecal material (autologous). The fecal material was admini...
31 CitationsSource
#1Sofie Ingdam Halkjær (Copenhagen University Hospital)H-Index: 9
Last. Andreas Petersen (Copenhagen University Hospital)H-Index: 43
view all 7 authors...
Objective IBS is associated with an intestinal dysbiosis and faecal microbiota transplantation (FMT) has been hypothesised to have a positive effect in patients with IBS. We performed a randomised, double-blind placebo-controlled trial to investigate if FMT resulted in an altered gut microbiota and improvement in clinical outcome in patients with IBS. Design We performed this study in 52 adult patients with moderate-to-severe IBS. At the screening visit, clinical history and symptoms were assess...
133 CitationsSource
#1Alexander C. Ford (University of Leeds)H-Index: 86
#2Lucinda A. Harris (Mayo Clinic)H-Index: 25
Last. Paul Moayyedi (McMaster University)H-Index: 115
view all 5 authors...
BACKGROUND: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder. Disturbances in the gastrointestinal microbiome may be involved in its aetiology. AIM: To perform a systematic review and meta-analysis to examine the efficacy of prebiotics, probiotics, synbiotics and antibiotics in IBS. METHODS: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched (up to July 2017). Randomised controlled trials (RCTs) recruiting adults with IBS, comparing prebiotics, probio...
198 CitationsSource
#1Gianluca Ianiro (UCSC: Catholic University of the Sacred Heart)H-Index: 36
#2Marcello MaidaH-Index: 20
Last. Giovanni Cammarota (UCSC: Catholic University of the Sacred Heart)H-Index: 62
view all 8 authors...
BackgroundProtocols for treating recurrent Clostridium difficile infection (rCDI) through faecal microbiota transplantation (FMT) are still not standardised. Our aim was to evaluate the efficacy of different FMT protocols for rCDI according to routes, number of infusions and infused material.MethodsMEDLINE, Embase, SCOPUS, Web of Science and the Cochrane Library were searched through 31 May 2017. Studies offering multiple infusions if a single infusion failed to cure rCDI were included. Data wer...
81 CitationsSource
#1Tom HolvoetH-Index: 33
#2Marie JoossensH-Index: 27
Last. Danny De LoozeH-Index: 16
view all 10 authors...
22 CitationsSource
#1Sean M P Bennet (University of Gothenburg)H-Index: 5
#2Lena Böhn (University of Gothenburg)H-Index: 6
Last. Magnus Simrén (University of Gothenburg)H-Index: 21
view all 9 authors...
Objective The effects of dietary interventions on gut bacteria are ambiguous. Following a previous intervention study, we aimed to determine how differing diets impact gut bacteria and if bacterial profiles predict intervention response. Design Sixty-seven patients with IBS were randomised to traditional IBS (n=34) or low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) (n=33) diets for 4 weeks. Food intake was recorded for 4 days during screening and interventi...
106 CitationsSource
#1Olga C. AroniadisH-Index: 13
#2Lawrence J. BrandtH-Index: 65
Last. Marla J. KellerH-Index: 23
view all 19 authors...
18 CitationsSource
#1Peter Holger Johnsen (UNN: University Hospital of North Norway)H-Index: 3
#2Frank HilpüschH-Index: 3
Last. Rasmus Goll (UNN: University Hospital of North Norway)H-Index: 23
view all 7 authors...
Summary Background Irritable bowel syndrome (IBS) is a common condition characterised by abdominal pain, bloating, and poor quality of life. IBS might be caused by a gut dysbiosis. We aimed to compare faecal microbiota transplantation (FMT) with placebo in patients with IBS. Methods In this double-blind, randomised, placebo-controlled, parallel-group, single-centre study, we enrolled patients with IBS with diarrhoea or with diarrhoea and constipation (excluding dominating constipation) defined b...
183 CitationsSource
Cited By61
#2Vineet AhujaH-Index: 39
#1Jun-Jie Hou (Tianjin Medical University General Hospital)
#2Xin Wang (Tianjin Medical University General Hospital)H-Index: 1
Last. Bangmao Wang (Tianjin Medical University General Hospital)H-Index: 21
view all 6 authors...
Abstract Irritable bowel syndrome (IBS) is a common functional gastrointestinal disease that affects 3.8–9.2% of the world population. It affects the physiology and psychology of patients and increases the burden on families, the healthcare system, society, and economic development. Presently, a large number of studies have shown that compared to healthy individuals, the composition and diversity of gut microbiota in IBS patients have changed, and the proteolytic activity (PA) in fecal supernata...
#1Simon Mark Dahl Baunwall (Aarhus University Hospital)H-Index: 2
#2Elisabeth M. Terveer (LUMC: Leiden University Medical Center)H-Index: 9
Last. Patrizia Kump (Medical University of Graz)H-Index: 13
view all 40 authors...
Abstract null null Background null Faecal microbiota transplantation (FMT) is an emerging treatment modality, but its current clinical use and organisation are unknown. We aimed to describe the clinical use, conduct, and potential for FMT in Europe. null null null Methods null We invited all hospital-based FMT centres within the European Council member states to answer a web-based questionnaire covering their clinical activities, organisation, and regulation of FMT in 2019. Responders were ident...
1 CitationsSource
#1Simon Mark Dahl Baunwall (Aarhus University Hospital)H-Index: 2
#2Jens Frederik Dahlerup (Aarhus University Hospital)H-Index: 36
Last. Anne A RodeH-Index: 2
view all 12 authors...
Aim: This Danish national guideline describes the treatment of adult patients with Clostridioides (formerly Clostridium) difficile (CD) infection and the use of faecal microbiota transplantation (FMT). It suggests minimum standard for implementing an FMT service.Method: Four scientific societies appointed members for a working group which conducted a systematic literature review and agreed on the text and recommendations. All clinical recommendations were evalluated for evidence level and grade ...
#1Prashant Singh (UM: University of Michigan)H-Index: 8
#1Prashant SinghH-Index: 58
Last. Anthony Lembo (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 71
view all 2 authors...
Advances in bioinformatics have facilitated investigation of the role of gut microbiota in patients with irritable bowel syndrome (IBS). This article describes the evidence from epidemiologic and clinical observational studies highlighting the link between IBS and gut microbiome by investigating postinfection IBS, small intestinal bacterial overgrowth, and microbial dysbiosis. It highlights the effects of gut microbiota on mechanisms implicated in the pathophysiology of IBS, including gut-brain ...
#1Gianluca Ianiro (Agostino Gemelli University Polyclinic)H-Index: 36
#2Federica Giambò (UCSC: Catholic University of the Sacred Heart)
Last. Giovanni Cammarota (Agostino Gemelli University Polyclinic)H-Index: 8
view all 3 authors...
#1David J. Sanders (UCL: University College London)H-Index: 1
#2Saskia Inniss (UCL: University College London)
Last. Andrew M. Smith (UCL: University College London)H-Index: 28
view all 5 authors...
The microbiome plays an important role in maintaining human health. Despite multiple factors being attributed to the shaping of the human microbiome, extrinsic factors such diet and use of medications including antibiotics appear to dominate. Mucosal surfaces, particularly in the gut, are highly adapted to be able to tolerate a large population of microorganisms while still being able to produce a rapid and effective immune response against infection. The intestinal microbiome is not functionall...
1 CitationsSource
#1Patrick Denis Browne (UCPH: University of Copenhagen)H-Index: 9
#2Frederik Cold (Copenhagen University Hospital)H-Index: 2
Last. Lars Hestbjerg Hansen (UCPH: University of Copenhagen)H-Index: 57
view all 7 authors...
Dysbiosis of the gut microbiome has been correlated with irritable bowel syndrome (IBS). Fecal microbiota transplantation (FMT) is being explored as a therapeutic option. Little is known of the mechanisms of engraftment of microbes following FMT and whether the engraftment of certain microbes correlate with clinical improvement in IBS. Microbiome data, from a previously reported placebo-controlled trial of treatment of IBS with FMT or placebo capsules, were used to investigate microbial engraftm...
#1Anna Maria Alcasid Madsen (Copenhagen University Hospital)
#2Sofie Ingdam Halkjær (Copenhagen University Hospital)H-Index: 9
Last. Andreas Petersen (Copenhagen University Hospital)H-Index: 43
view all 8 authors...
Irritable bowel syndrome (IBS) is associated with intestinal dysbiosis. Therefore, faecal microbiota transplantation (FMT) has been hypothesised to have a positive effect in patients with IBS. In t...
1 CitationsSource