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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Fecal microbiota transplantation for the treatment of irritable bowel syndrome: A systematic review and meta-analysis
Sofie Ingdam Halkjær, Bobby Lo, Frederik Cold, Alice Højer Christensen, Savanne Holster, Julia König, Robert Jan Brummer, Olga C Aroniadis, Perttu Lahtinen, Tom Holvoet, Lise Lotte Gluud, Andreas Munk Petersen
Sofie Ingdam Halkjær, Bobby Lo, Frederik Cold, Lise Lotte Gluud, Andreas Munk Petersen, Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
Sofie Ingdam Halkjær, Bobby Lo, Frederik Cold, Andreas Munk Petersen, Copenhagen IBD Center, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
Alice Højer Christensen, Department of Gastroenterology, Aleris-Hamlet Hospitals Copenhagen, Søborg 2860, Denmark
Savanne Holster, Julia König, Robert Jan Brummer, Nutrition-Gut-Brain Interactions Research Centre, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro 70362, Sweden
Olga C Aroniadis, Department of Internal Medicine, Division of Gastroenterology, Renaissance School of Medicine, Stony Brook University Hospital, New York, NY 11794-8434, United States
Perttu Lahtinen, Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti 15850, Finland
Perttu Lahtinen, Department of Medicine, University of Helsinki, Helsinki 00014, Finland
Tom Holvoet, Department of Gastroenterology, University Hospital Ghent, Ghent 9000, Belgium
Lise Lotte Gluud, Andreas Munk Petersen, Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
Andreas Munk Petersen, Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
Author contributions: Halkjær SI, Gluud LL and Petersen AM conceived the review; Halkjær SI, Lo B, Cold F, Højer Christensen A, Gluud LL and Petersen AM wrote the protocol for the review; Halkjær SI and Lo B searched and selected studies for the review; Halkjær SI, Lo B, Holster S, König J, Brummer RJ, Aroniadis OC, Holvoet T and Lahtinen P collected data for the review; Lo B, Cold F and Gluud LL assessed the risk of bias in the studies used; Halkjær SI, Lo B, Gluud LL and Petersen AM assessed the certainty of the evidence; Halkjær SI and Lo B interpreted the data; Halkjær SI and Lo B wrote the review; Halkjær SI, Lo B, Cold F, Højer Christensen A, Petersen AM, Holster S, König J, Brummer RJ, Aroniadis OC, Holvoet T, Lahtinen P and Gluud LL commented on the review. All authors have read and approved the final manuscript. None of the authors have extracted data from, or assessed the risk of bias in, trials they carried out themselves.
Conflict-of-interest statement: None of the authors report relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Sofie Ingdam Halkjær, MSc, PhD, Senior Researcher, Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Hvidovre 2650, Denmark. sofie.ingdam.halkjaer@regionh.dk
Received: February 22, 2023
Peer-review started: February 22, 2023
First decision: March 18, 2023
Revised: April 6, 2023
Accepted: April 18, 2023
Article in press: April 18, 2023
Published online: May 28, 2023
BACKGROUND
Irritable bowel syndrome (IBS) is the most prevalent gastrointestinal disorder in developed countries and reduces patients’ quality of life, hinders their ability to work, and increases health care costs. A growing number of trials have demonstrated an aberrant gut microbiota composition in IBS, also known as ‘gut dysbiosis’. Fecal microbiota transplantation (FMT) has been suggested as a treatment for IBS.
AIM
To assess the efficacy and safety of FMT for the treatment of IBS.
METHODS
We searched Cochrane Central, MEDLINE, EMBASE and Web of Science up to 24 October 2022 for randomised controlled trials (RCTs) investigating the effectiveness of FMT compared to placebo (including autologous FMT) in treating IBS. The primary outcome was the number of patients with improvements of symptoms measured using a validated, global IBS symptoms score. Secondary outcomes were changes in quality-of-life scores, non-serious and serious adverse events. Risk ratios (RR) and corresponding 95%CI were calculated for dichotomous outcomes, as were the mean differences (MD) and 95%CI for continuous outcomes. The Cochrane risk of bias tool was used to assess the quality of the trials. GRADE criteria were used to assess the overall quality of the evidence.
RESULTS
Eight RCTs (484 participants) were included in the review. FMT resulted in no significant benefit in IBS symptoms three months after treatment compared to placebo (RR 1.19, 95%CI: 0.68-2.10). Adverse events were reported in 97 participants in the FMT group and in 45 participants in the placebo group (RR 1.17, 95%CI: 0.63-2.15). One serious adverse event occurred in the FMT group and two in the placebo group (RR 0.42, 95%CI: 0.07-2.60). Endoscopic FMT delivery resulted in a significant improvement in symptoms, while capsules did not. FMT did not improve the quality of life of IBS patients but, instead, appeared to reduce it, albeit non significantly (MD -6.30, 95%CI: -13.39-0.79). The overall quality of the evidence was low due to moderate-high inconsistency, the small number of patients in the studies, and imprecision.
CONCLUSION
We found insufficient evidence to support or refute the use of FMT for IBS. Larger trials are needed.
Core Tip: We did not find evidence to support the use of fecal microbiota transplantation (FMT) for irritable bowel syndrome (IBS) patients outside of clinical trials in this systematic review and meta-analysis. We report possible beneficial effects when FMT is delivered by endoscopy (colonoscopy or gastroscopy). FMT appears to be safe compared to placebo in patients with IBS, regardless of route of administration. Further randomised clinical trials are necessary to clarify the effect, if any, of FMT in IBS.
