Fecal microbiota transplantation in irritable bowel syndrome: A meta-analysis of randomized controlled trials

Chatpol Samuthpongtorn; Piyawat Kantagowit; Rapat Pittayanon; Tanisa Patcharatrakul; Sutep Gonlachanvit

doi:10.3389/fmed.2022.1039284

Fecal microbiota transplantation in irritable bowel syndrome: A meta-analysis of randomized controlled trials

Front Med (Lausanne). 2022 Nov 3:9:1039284. doi: 10.3389/fmed.2022.1039284. eCollection 2022.

Authors

Chatpol Samuthpongtorn¹, Piyawat Kantagowit¹, Rapat Pittayanon², Tanisa Patcharatrakul^{2

3}, Sutep Gonlachanvit^{2

3}

Affiliations

¹ Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
² Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
³ Center of Excellence in Neurogastroenterology and Motility, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Abstract

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].

Keywords: dysbiosis; fecal microbiota transplantation; gastrointestinal diseases; irritable bowel syndrome; meta-analysis.

Publication types

Systematic Review