Faecal microbiota transplantation is effective for irritable bowel syndrome

The results of a double-blind, randomised, placebo-controlled study have confirmed that faecal microbiota transplantation (FMT) is an effective and well-tolerated treatment for irritable bowel syndrome (IBS), provided the donor is carefully selected.

Prof. Magdy El-Salhy (Haukeland University Hospital, Norway) reported high rates of clinical response and marked symptom improvements in a large cohort of patients with various subtypes of IBS [1]. The investigators used several novel methodologies, and highlighted the importance of donor selection for optimising the effectiveness of FMT as a treatment for IBS by using frozen samples from a single 'super-donor' on individuals in the current study.

"We set out to optimise our chances of treatment success by selecting a single, well-defined donor who fulfilled European guidelines for FMT donors, and who had a favourable faecal microbial profile," Prof. El-Salhy explained.

The study randomised 164 individuals with IBS and moderate-to-severe IBS symptoms to receive either 60 g placebo solution (derived from the patient’s own faeces), a 30 g donor transplant solution, or a 60 g transplant solution. Unlike in previous studies, the transplant material had been stored frozen (-80°C/-112°F), and was administered into the proximal duodenum with a gastroscope after thawing. This approach avoids the need for bowel preparation prior to transplantation, thereby making it more amenable to daily clinical practice. The primary efficacy endpoint of the study was the percentage of patients who achieved a 50-point reduction in IBS-Symptom scoring at 3 months after FMT.

A response to FMT treatment was observed in 23.6% of individuals who received placebo, 76.9% of individuals who received a 30 g transplant, and 89.1% of individuals who received a 60 g transplant. Clinically significant symptom improvement (i.e. a reduction in IBS-SSS) occurred in 5.5%, 35.2%, and 47.3% of individuals in the placebo, FMT 30 g, and FMT 60 g treatment groups, respectively. Significant improvements in fatigue (Fatigue Assessment Scale) and quality of life (IBS-Quality of Life instrument) were also observed in the FMT treatment groups compared with the placebo group. An analysis of faecal bacterial profiles showed changes in the abundance of different bacteria in the two FMT groups, but not in the control group.

Adverse events after FMT occurred in about 20% of patients and were mild and self-limiting gastrointestinal symptoms such as abdominal pain, diarrhoea, or constipation, usually occurring intermittently in the first 2 days following FMT.

Prof El-Salhy and colleagues believe this study confirms that FMT is an effective treatment for IBS, but stress the importance of using a “super-donor” to achieve treatment success. The use of frozen faeces eliminates the logistical problems associated with FMT involving fresh faeces, making it possible to establish biobanks for the routine use of FMT in clinical practice.

1. El-Salhy M. Effects of faecal microbiota transplantation in patients with irritable bowel syndrome (IBS): a randomised, double-blind placebo-controlled study. UEG Week Barcelona, Catalonia, Spain, October 19-23, 2019, Abstract OP004.

Posted on 23 October, 201918 March, 2021