- 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.
- 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.
- 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.
- 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.