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Systematic review with meta-analysis: efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome.
Aliment Pharmacol Ther 2019; 50(3):240-248AP

Abstract

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 clinicaltrials.gov 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.

Authors+Show Affiliations

Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK. Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK. Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31136009

Citation

Ianiro, Gianluca, et al. "Systematic Review With Meta-analysis: Efficacy of Faecal Microbiota Transplantation for the Treatment of Irritable Bowel Syndrome." Alimentary Pharmacology & Therapeutics, vol. 50, no. 3, 2019, pp. 240-248.
Ianiro G, Eusebi LH, Black CJ, et al. Systematic review with meta-analysis: efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2019;50(3):240-248.
Ianiro, G., Eusebi, L. H., Black, C. J., Gasbarrini, A., Cammarota, G., & Ford, A. C. (2019). Systematic review with meta-analysis: efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome. Alimentary Pharmacology & Therapeutics, 50(3), pp. 240-248. doi:10.1111/apt.15330.
Ianiro G, et al. Systematic Review With Meta-analysis: Efficacy of Faecal Microbiota Transplantation for the Treatment of Irritable Bowel Syndrome. Aliment Pharmacol Ther. 2019;50(3):240-248. PubMed PMID: 31136009.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systematic review with meta-analysis: efficacy of faecal microbiota transplantation for the treatment of irritable bowel syndrome. AU - Ianiro,Gianluca, AU - Eusebi,Leonardo H, AU - Black,Christopher J, AU - Gasbarrini,Antonio, AU - Cammarota,Giovanni, AU - Ford,Alexander C, Y1 - 2019/05/28/ PY - 2019/03/29/received PY - 2019/04/21/revised PY - 2019/05/09/accepted PY - 2019/5/29/pubmed PY - 2019/5/29/medline PY - 2019/5/29/entrez SP - 240 EP - 248 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 50 IS - 3 N2 - 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 clinicaltrials.gov 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. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/31136009/Systematic_review_with_meta_analysis:_efficacy_of_faecal_microbiota_transplantation_for_the_treatment_of_irritable_bowel_syndrome_ L2 - https://doi.org/10.1111/apt.15330 DB - PRIME DP - Unbound Medicine ER -