Plain language summary
Repopulating an individual’s digestive tract with bacteria, using the faeces of a healthy donor, has been tested for the treatment of pathogens such as Clostridium Difficile, inflammatory bowel diseases and Irritable Bowel Syndrome. This small, single blind, controlled trial aimed to assess the effects of faecal transplant in patients with slow-transit constipation. The patients involved in the trial were split into two groups. One group (control) received standard education, behavioural strategies and oral laxatives only. The other group (intervention) received the conventional treatment as above and in addition, 6 days of faecal transplant during the first week of the 12 week trial. After 12 weeks, the trial found a significant difference in the number of people in the intervention group having a bowel movement more than 3 times per week, when compared to the control group (36% v. 13%). Other markers of constipation were also improved in the intervention group, such as stool consistency and colonic transit time. The authors conclude that faecal transplant is a significantly more effective treatment for slow-transit constipation than conventional treatment.
Abstract
Fecal microbiota transplantation has been proposed as a therapeutic approach for chronic constipation. This randomized, controlled trial aimed to compare the effects of conventional treatment alone (control) with additional treatment with FMT (intervention) in patients with slow-transit constipation (STC). Adults with STC were randomized to receive intervention or control treatment. The control group received education, behavioral strategies, and oral laxatives. The intervention group was additionally provided 6 days of FMT. The primary endpoint was the clinical cure rate (proportion of patients achieving a mean of ≥ three complete spontaneous bowel movements [CSBMs] per week]. Secondary outcomes and safety parameters were assessed throughout the study. Sixty patients were randomized to either conventional treatment alone (n = 30) or FMT (n = 30) through a nasointestinal tube. There were significant differences between the intervention group and control group in the clinical improvement rate (intention-to-treat [ITT]: 53.3% vs. 20.0%, P = 0.009), clinical cure rate (ITT: 36.7% vs. 13.3%, P = 0.04), mean number of CSBMs per week (ITT: 3.2 ± 1.4 vs. 2.1 ± 1.2, P = 0.001), and the Wexner constipation score (ITT: 8.6 ± 1.5 vs. 12.7 ± 2.5, P < 0.00001). Compared with the control group, the intervention group showed better results in the stool consistency score (ITT: 3.9 vs. 2.4, P < 0.00001) and colonic transit time (ITT: 58.5 vs. 73.6 h, P < 0.00001). The intervention group had more treatment-related adverse events than did the control group (50 vs. 4 cases). FMT was significantly more effective (30% higher cure rate) for treatment of STC than conventional treatment. No serious adverse events were observed.
Methodological quality
Allocation concealment
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Not applicable
