Efficacy of Fecal Microbiota Transplantation in Irritable Bowel Syndrome: A Meta-Analysis of Randomized Controlled Trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 35295757 · doi:10.3389/fcimb.2022.827395
What was done
MEDLINE, EMBASE, and Cochrane Central Register were searched through September 2021 for randomized controlled trials (RCTs) comparing fecal microbiota transplantation (FMT) with placebo in adults with irritable bowel syndrome (IBS). Dichotomous response data were pooled for relative risk (RR) of symptoms not improving and adverse events. Continuous data were pooled for mean difference in IBS-Quality of Life (IBS-QoL) at 12 weeks. GRADE was used to assess evidence certainty.
What was found
Seven RCTs with 472 patients were included. At 12 weeks, FMT did not significantly improve global IBS symptoms compared to placebo (RR 0.75, 95% CI 0.43 to 1.31) with high heterogeneity (I² = 87%). Subgroup analyses by route found FMT superior to placebo via colonoscopy (RR 0.70, 95% CI 0.51 to 0.96) or gastroscope (RR 0.37, 95% CI 0.14 to 0.99), but inferior via oral capsules (RR 1.88, 95% CI 1.06 to 3.35). IBS-QoL improved significantly at 12 weeks (mean difference 9.39, 95% CI 3.86 to 14.91). Adverse events did not differ significantly (RR 1.20, 95% CI 0.59 to 2.47). At 1-year follow-up, FMT did not significantly improve global symptoms (RR 0.90, 95% CI 0.72 to 1.12). GRADE certainty was rated as very low.
Why it matters
FMT does not show overall efficacy for global IBS symptoms compared to placebo, though administration route appears to alter treatment response.
Limits
The total sample size was small across only 7 RCTs (n = 472), heterogeneity was high (I² = 87%), findings diverged substantially by delivery route, and the GRADE quality of evidence was very low.
Cited by
- supports Clinical trials of fecal microbiota transplantation for irritable bowel syndrome have generally failed to show strong positive patient outcomes.