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  • Irritable Bowel Syndrome (IBS)

    Approximately 11.2% of people worldwide suffer from Irritable Bowel Syndrome (IBS), which is associated with a significant reduction in the quality of patients’ life due to discomfort and abdomen pain, irregular bowel movements (diarrhea or constipation), and flatulence. Irritable Bowel Syndrome is a chronic, non-inflammatory disease. Depending on the form of the disease, symptomatic treatment with loperamide (diarrheal form) or polyethylene glycol (constipation form) is used. In addition, people with irritable bowel syndrome are advised to follow a low-FODMAP diet appropriately modified to the present symptoms.

    The intestinal microbiota maintains the integrity of the intestinal barrier and influences the work of the immune system, including the progression of inflammation. The etiology of IBS is not fully understood, but it is believed that intestinal bacteria may play a vital role in the course of the disease and the severity of symptoms. One of the factors in the pathogenesis of Irritable Bowel Syndrome is the reduced diversity of bacteria in the patient’s gut.

    In recent years, researchers have checked whether FMT contributes to the resolution of IBS symptoms. The most thorough study was conducted by El-Salhy et al., in which 165 patients with long-lasting IBS symptoms participated. During the research on the microbiota, it was proven that about 60% of the studied patients were in a state of dysbiosis. Then, the study participants assessed their well-being, fatigue, and quality of life before and several times after the FMT procedure. Within three months, 89.1% of patients who received a dose of 60 g of FMT, 76.9% of those who received 30 g of FMT, and only 23.6% of patients in the control group (placebo) responded to treatment. Patients in the placebo, 30 g, and 60 g groups achieved an improvement in the well-being of 5.5%, 35.2%, and 47.3%, respectively. The results were statistically significant and not dependent on sex, age, form, or disease duration. Altered amounts of Eubacterium biforme, Lactobacillus spp., Alistipes spp., Bacteroides spp. were observed. Some of these bacteria were correlated with positive patient response and symptom reduction in patients given 30 g or 60 g of FMT. Other studies have shown different efficacy of gut microbiota transplantation, which may be due to group variability, administered dose, method of administration, or donor choice. Due to different results, research on the influence of intestinal microbiota transplantation on remission of irritable bowel syndrome should be continued.

    Publication

    El-Salhy et al. 2019

    Study design

    A double blind, randomized, placebo-controlled study

    Country

    Norway

    Sample size (n)

    N = 165 (30 g FMT=55, 60 g FMT=55, control=55)

    Follow-up period

    3 months

    Specific disorder

    IBS

    Age in years (mean)

    30 g FMT group: 39.2
    60 g FMT group: 39.3
    Control group: 41.2

    Intervention

    30 g and 60 g FMT: TAU plus NGT
    Control: As above, but 30 g autologous FMT used.

    POM

    Reduction in the IBS-SSS total score of >= 50 points during the 3 month period following FMT

    Results

    Favor FMT

    Responses occurred after

    3 months 30 g FMT and 60 g FMT groups (p<0.0001). Significant improvement in the mental health based on sub-score of FAS in both groups after 3 months compared with placebo (p<0.05)

    Table 1. El-Salhy et al. study of efficacy of FMT for IBS patients [https://doi.org/10.1080/19490976.2020.1854640]

    References

    Green, J. E., Davis, J. A., Berk, M., Hair, C., Loughman, A., Castle, D., Athan, E., Nierenberg, A. A., Cryan, J. F., Jacka, F., & Marx, W. (2020). Efficacy and safety of fecal microbiota transplantation for the treatment of diseases other than Clostridium difficile infection: a systematic review and meta-analysis. Gut microbes, 12(1), 1–25. https://doi.org/10.1080/19490976.2020.1854640

    Wortelboer, K., Nieuwdorp, M., & Herrema, H. (2019). Fecal microbiota transplantation beyond Clostridioides difficile infections. EBioMedicine, 44, 716–729. https://doi.org/10.1016/j.ebiom.2019.05.066

    El-Salhy M, Hatlebakk JG, Gilja OH, Bråthen Kristoffersen A, Hausken T. Efficacy of faecal microbiota transplantation for patients with irritable bowel syndrome in a randomised, double-blind, placebo-controlled study. Gut. 2020 May;69(5):859-867. doi: 10.1136/gutjnl-2019-319630. Epub 2019 Dec 18. PMID: 31852769; PMCID: PMC7229896.

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