Sustained response to faecal microbiota transplantation

 

Most IBS patients who responded to faecal microbiota transplantation after 3 months maintained this response at 1 year after the intervention. In this study from Norway, the improvements in symptoms and quality of life increased significantly over time [1]. Sustained changes in the faecal bacteriome and consequent short-chain fatty acid metabolites seemed to associate with better clinical outcomes.

A recently published study from Norway showed that faecal microbiota transplantation is an effective and safe treatment for patients with irritable bowel syndrome (IBS) after 3 months [2]. The current follow-up study investigated the efficacy and safety of faecal microbiota transplantation at 1 year after this intervention.

The response to faecal microbiota transplantation was maintained at 1 year after treatment in 86.5% and 87.5% of patients who received 30 g and 60 g faecal microbiota transplantation, respectively. In the 30 g faecal microbiota transplantation group, 21.6% of patients showed complete remission (IBS-Severity Scoring System total score of ≤75) after 3 months, which increased to 32.4% at 1 year. In the group receiving 60 g, the percentage of patients with a complete remission increased from 27.5% after 3 months to 45% at 1 year. Abdominal symptoms, fatigue, and quality of life were also improved at 1 year compared with 3 months after faecal transplantation.

These findings were accompanied by a significant improvement in the dysbiosis index and comprehensive changes in the faecal bacterial profile. The levels of Alistipes spp. were significantly lower in the relapsed patients at baseline than in the responders and patients in remission at 1 year after faecal microbiota transplantation. Thus, Alistipes spp. seem to play a central role in the improvements seen after faecal transplantation. Levels of Alistipes spp. were postulated to be used to predict the outcome of faecal microbiota transplantation. The reduction of acetic acid levels could be relevant since acetic acid has been found to induce visceral hypersensitivity in rodents.

Changes in the levels of faecal short-chain fatty acids indicated that the microbial metabolism changed from a saccharolytic to a proteolytic fermentation pattern in IBS patients at 1 year after faecal transplantation. The level of faecal acetic acid was reduced compared with baseline. Furthermore, the clinically relapsed patients had significantly lower fatigue scores and significant changes in the bacterial profile and the levels of short-chain fatty acids compared with baseline.

The finding that faecal microbiota transplantation induced remission in about half of the patients with IBS emphasises the role of the intestinal microbiota in the aetiology of IBS.

1. El-Salhy M. Long-term effects of faecal microbiota transplantation (FMT) in patients with irritable bowel syndrome. UEG Week Virtual Symposium 2020, abstract OP059.
2. El-Salhy M, et al. Gut. 2020 May;69(5):859-867.

Posted on 2 November, 20202 November, 2020