Fecal microbiota transplantation for irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials

Front Immunol. 2023 May 18:14:1136343. doi: 10.3389/fimmu.2023.1136343. eCollection 2023.

Abstract

Objective: Whether fecal microbiota transplantation (FMT) in patients with irritable bowel syndrome (IBS) is effective in improving outcomes remains controversial. We assessed the safety and efficacy of FMT for patients with IBS.

Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, the Cochrane Library, the clinicaltrials.gov and International Clinical Trials Registry Platform (ICTRP) up to February 25, 2022, updated to March 28, 2023. Randomized controlled trials (RCTs) compared the stool and capsule FMT with placebo in patients with IBS were included. Two authors independently assessed study eligibility, extracted the data, and assessed risk of bias. We did meta-analysis with RevMan, and the Stata software was used for sensitivity analysis and meta-regression. The GRADE system was used to assess the quality of evidences. Mean difference (MD) or standardized Mean difference (SMD) with 95% CI for continuous data, and risk ratios (RR) with 95% CI for dichotomous data were used with random-effects models. The primary outcomes included the clinical response rate and IBS-SSS score. This study is registered with PROSPERO: CRD42022328377.

Results: Nineteen reports from nine RCTs were included finally. Compared with the placebo, a single stool FMT could significantly decrease the IBS-SSS score at 1 month (MD=-65.75, 95%CI [-129.37, -2.13]), 3 months (MD=-102.11, 95% CI [-141.98, -62.24]), 6 months (MD=-84.38, 95%CI [-158.79, -9.97]), 24 months (MD=-110.41, 95%CI [-145.37, -75.46]), and 36 months (MD=-104.71, 95%CI [-137.78, -71.64]). It also could improve the clinical response rate at 3 months (RR=1.91, 95% [1.12, 3.25]), 24 months (RR=2.97, 95% [1.94, 4.54]), and 36 months (RR=2.48, 95% [1.65, 3.72]), and increase the IBS-QoL score at 3 months, 24 months, and 36 months. FMT did not increase the serious adverse event. The risk of bias was low, and the quality of evidence based on GRADE system was moderate in the stool FMT group. However, we did not find positive effect of capsule FMT on patients with IBS based on the current available data.

Conclusion: A single stool FMT is effective and safe for patients with IBS. However, some factors may affect the effectiveness of FMT, and the relationship between the gut microbiome and the effect of FMT for IBS is still unclear.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022328377.

Keywords: fecal microbiota transplantation; gut microbiome; influence factor; irritable bowel syndrome; meta-analysis; systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Fecal Microbiota Transplantation / adverse effects
  • Feces
  • Gastrointestinal Microbiome* / physiology
  • Humans
  • Irritable Bowel Syndrome* / therapy
  • Randomized Controlled Trials as Topic

Grants and funding

This study was supported by the National Natural Science Foundation of China (82060800), Gansu Province Youth Science and Technology Fund program (20JR10RA759), Health industry science and technology plan of Gansu Province (GSWSKY2020-30), Natural Science Foundation of Gansu Province (22JR5RA189), Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital (CY2021-QN-A01), and the Fundamental Research Funds for the Central Universities (31920200047). The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.