Fecal microbiota transplant improved or alleviated symptoms in 70% of patients with refractory irritable bowel syndrome, a small retrospective study has determined.
A single transfusion of fresh donor feces improved abdominal pain, bowel habits, dyspepsia, bloating, and flatulence, Dr. Olga Aroniadis reported at the meeting sponsored by the American Gastroenterological Association.
Dr. Olga C. Aroniadis
For some patients, noticeable improvement occurred within days, Dr. Aroniadis of Montefiore Medical Center, New York, said in an interview. "For others it took longer, but in those who felt better, they did so within a matter of weeks."
The study followed 13 patients for an average of 11 months. All had irritable bowel syndrome (IBS) that was refractory to diet, probiotic, antibiotic, and/or antidepressant therapy.
The main outcome was assessed by a 41-item questionnaire that evaluated severity of abdominal pain, bloating, flatus, diarrhea, constipation, and overall quality of life.
Most of the patients (7/13) were women. The diagnoses were diarrhea-predominant IBS (nine), constipation-predominant IBS (three), and mixed IBS (one).
The donor pool comprised patients’ relatives, spouses, or close friends. The transfusion was delivered once by upper endoscopy.
Overall, 9 patients of 13 experienced symptom resolution or improvement.
At baseline, 11 patients had abdominal pain. This resolved in three, improved in five, and remained unchanged in three.
Abdominal bloating was present in 12 patients at baseline. This resolved in two, improved in four, and remained unchanged in six.
Flatus, present in 12 at baseline, resolved in one, improved in four, did not change in six, and worsened in one.
Of six patients with dyspepsia, two reported resolution, two noted improvement, and two had no change.
Before the transplant, none of the patients scored their quality of life as "good;" four scored it as "acceptable" and nine as "poor." After fecal transplant, status changed to "good" in three, "acceptable" in six, and "poor" in four.
There has been speculation about whether a family member, household member, or someone else is the ideal donor for fecal transplant; however, this study wasn’t powered to address this, Dr. Aroniadis said. "That’s an important question but we didn’t have a sufficient number of patients to make those inferences. It’s something we do need to look at in the future, although I suspect that use of a standard donor will become commonplace."
Picking the optimal donor probably depends on accurately detailing the microbiome of both donor and recipient. "In the future, we hope to develop an individual approach to FMT [fecal microbiota transplant], but to do this, we need to know which specific bacterial populations need to be restored in each patient, and that is several years away."
Patients responded to FMT regardless of IBS subtype, however, the numbers of patients in each group were too few to perform a statistical comparison. Dr. Aroniadis and her colleagues are planning a randomized controlled trial that will enroll only patients with diarrhea-predominant IBS. "We will have a much better sense of the efficacy of FMT for the treatment of diarrhea-predominant IBS after we conduct our clinical trial."
The present study is the first to track fecal transplant response exclusively in IBS patients, Dr. Aroniadis said. Two other observational studies that looked at the efficacy of FMT for functional gastrointestinal diseases included a study of patients with inflammatory bowel disease and IBS, and another study of patients with chronic constipation. "The results were promising in both of these studies." she said.
She and her colleagues are planning a randomized controlled trial that will focus exclusively on patients with diarrhea-predominant IBS. Participants enrolled in the trial will undergo microbiome analyses before and after fecal transplant, which she hopes will shed some light on how alteration of the intestinal microbiota correlates with symptoms.
Dr. Aroniadis had no financial disclosures.