Fecal Microbiota Transplantation in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 37834010 · doi:10.3390/ijms241914562
What was done
A systematic review and meta-analysis of randomized controlled trials was conducted using PubMed/Medline and Embase through June 14, 2023. The authors assessed the efficacy of fecal microbiota transplantation (FMT) in reducing irritable bowel syndrome (IBS) symptoms overall and across subgroups categorized by placebo type (autologous FMT vs. non-FMT), FMT preparation (single vs. multiple donors), dosing frequency (single vs. multiple doses), and administration route (such as lower gastrointestinal delivery via colonoscopy).
What was found
Seven randomized controlled trials were included from 1,015 records. Overall FMT did not significantly improve IBS symptoms compared to control (OR = 0.99, 95% CI 0.39–2.5). Subgroup analyses showed: - Multiple doses vs. non-FMT placebo: OR = 0.32, 95% CI 0.07–1.32, p = 0.11 (not significant). - Single-donor FMT vs. autologous FMT placebo: OR = 1.67, 95% CI 0.59–4.67, p = 0.32 (not significant). - Single dose of multiple-donor FMT vs. autologous FMT placebo: OR = 2.54, 95% CI 1.20–5.37, p = 0.01 (statistically significant). - Lower GI administration vs. autologous FMT placebo: OR = 2.2, 95% CI 1.20–4.03, p = 0.01 (statistically significant). Included studies were reported to have low risk of bias and no publication bias.
Why it matters
Broad pooling of FMT trials in IBS shows no overall therapeutic benefit, but clinical efficacy appears dependent on specific protocol parameters, specifically single-dose, multiple-donor FMT delivered directly to the lower gastrointestinal tract.
Limits
The meta-analysis included only 7 randomized controlled trials, and the total participant sample size was not reported in the abstract. Substantial heterogeneity in donor selection, delivery routes, and placebo types led to wide confidence intervals in several subgroups, and long-term durability of symptom relief was not described.
Cited by
- supports Clinical trials of fecal microbiota transplantation for irritable bowel syndrome have generally failed to show strong positive patient outcomes.