A systematic review, pairwise meta-analysis and network meta-analysis of randomized controlled trials exploring the role of fecal microbiota transplantation in irritable bowel syndrome.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials
PubMed 36719820 · doi:10.1097/MEG.0000000000002519
What was done
A systematic review, pairwise meta-analysis, and Bayesian network meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy and safety of fecal microbiota transplantation (FMT) in irritable bowel syndrome (IBS). The authors searched literature databases (yielding 510 initial records) and analyzed 7 RCTs totaling 470 patients and controls. The trials evaluated four delivery routes: colonoscopy, nasojejunal tube, duodenoscope, and oral capsules.
What was found
In the primary pairwise meta-analysis, pooled FMT showed no statistically significant superiority over placebo. However, subgroup analyses found significant efficacy for upper gastrointestinal routes (duodenoscope and nasojejunal tube). In the network meta-analysis, 60-g FMT delivered via duodenoscope demonstrated the highest efficacy versus controls (OR 26.38, 95% CI 9.22–75.51) and ranked highest among all tested modalities (surface under the cumulative ranking curve [SUCRA] 98.8%).
Why it matters
These findings suggest that FMT efficacy in IBS depends heavily on delivery route and dose, explaining past conflicting trial results and pointing toward upper gastrointestinal delivery for future clinical development.
Limits
The total evidence base is small (7 trials, 470 participants) split across four distinct administration routes and varying dosages. The abstract does not report specific safety metrics, long-term durability of response, or IBS subtype stratification.
Cited by
- supports Clinical trials of fecal microbiota transplantation for irritable bowel syndrome have generally failed to show strong positive patient outcomes.