University of Utah School of Medicine salt lake city, UT, United States
Babu Mohan, MD1, Shahab R. Khan, MBBS2, Gauri Garg, MS3, Saurabh Chandan, MD4, Douglas Adler, MD5 1University of Utah School of Medicine, Salt Lake City, UT; 2Brigham & Women's Hospital, Harvard Medical School, Boston, MA; 3University of Utah, Salt Lake City, UT; 4Creighton University School of Medicine, Omaha, NE; 5Center for Advanced Therapeutic Endoscopy, Salt Lake City, UT
Introduction: Irritable bowel syndrome (IBS) is one of the most frequently encountered clinical diagnosis in gastroenterology clinics. Treatment of IBS can be as challenging as understanding its pathophysiology. The etiology remains unknown although theories like altered gut motility, gut-brain interaction and microbiome have been proposed. With the expanding understanding of gut microbiome, fecal microbiota transplant (FMT) has been tried with unclear success in IBS. Latest college guidelines recommend against FMT in IBS. However this is based on weak evidence. We conducted this meta-analysis to study the pooled rates of clinical outcomes of treatment of IBS with FMT.
Methods: Multiple databases including Medline, Scopus, Embase were searched from inception to May 2021 for studies evaluating the clinical outcomes of FMT in IBS. Studies that reported on FMT administration by invasive means such as naso-jejunal tube, upper endoscopy, or colonoscopy were included. Studies that reported on FMT administration via oral capsules were excluded due to previously reported inconsistency in results. Outcomes of interest were the improvement in IBS symptoms, IBS-symptom severity score, IBS-quality of life. Standard meta-analysis methods were employed using the random-effects model and study heterogeneity was assessed using the I2% and 95% prediction interval statistics.
Results: 5 studies were included in the final analysis, 3 of which were randomized controlled trials. 96 patients were in study group who received FMT and 62 received placebo. Study participants received FMT via naso-jejunal tube in 1 study, upper endoscopy in 1 study, and via colonoscopy in 3 studies. All studies were consistent in using the ROME-III criteria to establish IBS. The pooled odds ratio of improvement in IBS symptoms among patients who received FMT vs placebo was 3.7 (95% CI 1.6-8.6), and was statistically significant (p=0.001); I2%=62; 95% prediction interval=0.2 to 56.
Discussion: Our data suggests that patients who are treated via invasive route of FMT delivery demonstrate statistically significant odds ratio of improvement in IBS symptoms when compared to placebo, albeit limited by heterogeneity. The 95% prediction interval crosses 1, which suggests that the current results might not be true in the real world. However, only three studies used colonoscopy as the means of FMT delivery, and promising data might emerge in the future with more studies evaluating the outcomes of FMT delivered via colonoscopy in the treatment of IBS.
Figure: Figure 1: Forest plot
Disclosures: Babu Mohan indicated no relevant financial relationships. Shahab Khan indicated no relevant financial relationships. Gauri Garg indicated no relevant financial relationships. Saurabh Chandan indicated no relevant financial relationships. Douglas Adler indicated no relevant financial relationships.
Babu Mohan, MD1, Shahab R. Khan, MBBS2, Gauri Garg, MS3, Saurabh Chandan, MD4, Douglas Adler, MD5. P2483 - Clinical Outcomes of Fecal Microbiota Transplantation in Patients With Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.