IBS: stool transplants don’t seem to work

  • Xu D & al.
  • Am J Gastroenterol
  • 20 Mar 2019

  • International Clinical Digest
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Takeaway

  • For the treatment of irritable bowel syndrome (IBS), the scarce existing evidence does not support use of fecal microbiota transplantation (FMT).
  • Questions remain, e.g., about route.

Why this matters

  • IBS is the most commonly diagnosed gastroenterological condition and can hurt QoL.
  • Most patients continue to have symptoms in spite of treatment.
  • Gut microbiome is less diverse than in people without IBS.

Key results

  • Overall, evidence quality was very low.
  • FMT vs placebo:
    • Similar overall clinical response at 12 weeks: 49.3% (75/152) vs 51.0% (52/102).
    • Similar global improvement: relative risk, 0.93 (95% CI, 0.48-1.79; P=.83).
    • Similar adverse event rate.
    • Subgroup analyses suggested route of administration could make a difference.

Study design

  • Systematic review and meta-analysis of 4 randomized controlled trials comparing FMT vs placebo (either autologous FMT or excipients) for treatment of Rome III-criteria-diagnosed IBS in adults (n=254).
  • Outcome: global improvement in global IBS symptoms 8-12 weeks after FMT.
  • Funding: NIH.

Limitations

  • Small studies; 2 were abstracts with unclear bias risk.
  • Significant heterogeneity among studies.
  • Not enough studies to check for publication bias.
  • Placebos may have unanticipated effects of their own, muddying results.

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