Letters To The Editor
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 6, 2017; 8(4): 208-209
Published online Nov 6, 2017. doi: 10.4292/wjgpt.v8.i4.208
Fecal microbiota transplantation against irritable bowel syndrome? Rigorous randomized clinical trials are required
Amin Talebi Bezmin Abadi
Amin Talebi Bezmin Abadi, Department of Bacteriology, Faculty of Medical Science, Tarbiat Modares University, Tehran 14115, Iran
ORCID number: Amin Talebi Bezmin Abadi (0000-0001-5209-6436).
Author contributions: Abadi ATB designed the paper and approved the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Amin Talebi Bezmin Abadi, PhD, Assistant Professor, Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, P.O. Box 111, Tehran 14115, Iran. amin.talebi@modares.ac.ir
Telephone: +98-21-82884883 Fax: +98-21-82884883
Received: June 18, 2017
Peer-review started: June 21, 2017
First decision: July 26, 2017
Revised: July 26, 2017
Accepted: September 5, 2017
Article in press: September 6, 2017
Published online: November 6, 2017

Abstract

Halkjær et al searched systematically nine articles including 48 patients, and concluded that fecal microbiota transplantation (FMT) can be an ideal treatment option for irritable bowel syndrome (IBS) subjects. Regardless of the few successes in current traditional therapies (change in diet, herbal medicine and antibiotics) in IBS, a sharp increase in interests in the FMT option has been reported in the current century. However, there is a long list of unclear issues concerning the application of FMT for the treatment of IBS. Route of delivery and optimum dosage are the major concerns to consider before using in clinical practice.

Key Words: Fecal microbiota transplantation, Irritable bowel syndrome, Microbiota, Dysbiosis

Core tip: Apart from the interesting report by Halkjær et al, there is a long list of tasks concerning the application of fecal microbiota transplantation for the treatment of irritable bowel syndrome. Route of delivery and optimum dosage are the major concerns to consider before using in clinical practice.



TO THE EDITOR

I read with interest the article, “Can fecal microbiota transplantation cure irritable bowel syndrome?”[1]. Halkjær et al[1] searched systematically nine articles including 48 patients, and concluded that fecal microbiota transplantation (FMT) can be an ideal treatment option for irritable bowel syndrome (IBS) subjects. Regardless of the few successes in current traditional therapies (change in diet, herbal medicine and antibiotics) in IBS, a sharp increase in interests in FMT option has been reported in the current century. The authors mentioned most of the important findings, but I have some concerns on their interesting paper.

First, the etiology of IBS cannot be elucidated by a unique mechanism, thus many of these unknown involved items are acting without examination by the clinicians and microbiologists. However, in order to provide a better therapeutic approach, we need to determine the actual impact on those uninvestigated factors[2,3]. Second, although Halkjær et al[1] found no adverse effects of all of the included studies, statistically it may be a result of weak sampling (48 patients). This lack can be compensated by further research using larger sample size to present statistically significant results. Third, the current data is not sufficient for recommending FMT as the cure of IBS, at least based on the available evidence provided by this review[1]. In the near future, more research, including controlled and randomized trials, are necessary, which can likely answer those questions.

According to the current study, FMT is able to affect therapy of IBS, at least based on the 48 subjects investigated. As a note, we are still unaware of the exact mechanistic collaboration occurring between host cells and the microbiota. Of course, new evidence describing this question can shed promising light on the better application of FMT, not only against IBS but also for other important gastric clinical disorders (Clostridium difficile and Helicobacter pylori)[4,5]. Once again, I should appreciate the paper by Halkjær et al since it invites the attentions to using FMT as a new approach to treating any of the gastroduodenal disorders.

Indeed, there is a long list of unclear subjects concerning the application of FMT for the treatment of IBS. Route of delivery and optimum dosage are the major concerns to consider before using in clinical practice.

Footnotes

Manuscript source: Unsolicited manuscript

Specialty type: Gastroenterology and hepatology

Country of origin: Iran

Peer-review report classification

Grade A (Excellent): 0

Grade B (Very good): B

Grade C (Good): C, C

Grade D (Fair): D

Grade E (Poor): 0

P- Reviewer: Chen JX, Cao HL, Soares RLS, Tandon RK S- Editor: Qi Y L- Editor: Filipodia E- Editor: Lu YJ

References
1.  Halkjær SI, Boolsen AW, Günther S, Christensen AH, Petersen AM. Can fecal microbiota transplantation cure irritable bowel syndrome? World J Gastroenterol. 2017;23:4112-4120.  [PubMed]  [DOI]
2.  Talebi Bezmin Abadi A. Letter: more studies are needed to elucidate any association between Helicobacter pylori infection and Barrett’s metaplasia. Aliment Pharmacol Ther. 2017;45:764-765.  [PubMed]  [DOI]
3.  Sonnenberg A, Turner KO, Spechler SJ, Genta RM. The influence of Helicobacter pylori on the ethnic distribution of Barrett’s metaplasia. Aliment Pharmacol Ther. 2017;45:283-290.  [PubMed]  [DOI]
4.  Abadi AT, Kusters JG. Management of Helicobacter pylori infections. BMC Gastroenterol. 2016;16:94.  [PubMed]  [DOI]
5.  Lacy BE. Diagnosis and treatment of diarrhea-predominant irritable bowel syndrome. Int J Gen Med. 2016;9:7-17.  [PubMed]  [DOI]