Increasing the Dose and/or Repeating Faecal Microbiota Transplantation (FMT) Increases the Response in Patients with Irritable Bowel Syndrome (IBS).

Nutrients. 2019;11(6)
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Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder which can significantly affect patients’ quality of life. Various factors seem to be involved in the development of IBS, of which an imbalanced gut flora appears to be one. Faecal microbiota transplantation (FMT, the implantation of gut bacteria from a healthy donor to a person whose gut bacterial balance is disrupted) has been used successfully in IBS patients in some but not other clinical trials. The aim of this open-label study was to establish whether IBS patients who were non-responders to a 30g dose of FMT from a “superdonor” (a healthy person with a favourable bacterial composition) would respond to a 60g transplant from the same donor. The ten patients provided a stool sample before and 1 month after FMT to evaluate their bacterial composition. Questionnaires on symptoms, fatigue and quality of life were completed before and at 2 weeks, 1 and 3 months after FMT. Seven of the ten patients who had not responded to the 30g dose of FMT, responded to a 60g dose, with improvements in IBS symptom, fatigue and quality of life scores, as well as dysbiosis index determined with the stool samples. The authors conclude that FMT is an effective treatment for IBS. They point out that success is dependent on the availability of a “superdonor” and that high-dose and/or repeating FMT are required.

Abstract

BACKGROUND Faecal microbiome transplantation (FMT) appears to be an effective method for treating irritable bowel syndrome (IBS) patients. However, it is not clear if a high transplant dose and/or repeating FMT are/is needed to ensure a response. The present study was undertaken to clarify this matter. METHODS Ten IBS patients who did not respond to a 30-g transplant subsequently received a 60-g transplant into the duodenum via a gastroscope. The patients provided faecal samples before and 1 month after FMT. They completed five questionnaires measuring symptoms, fatigue and quality of life at baseline and then at 2 weeks, 1 month and 3 months after FMT. The dysbiosis index (DI) was measured using the GA-map Dysbiosis Test®. RESULTS Seven patients (70%) responded to the 60-g transplant, with significant clinical improvements in the abdominal symptoms, fatigue and quality of life in 57%, 80% and 67% of these patients. The 60-g transplant also reduced the DI. CONCLUSION FMT is an effective treatment for IBS. A high-dose transplant and/or repeated FMT increase the response rate and the intensity of the effects of FMT.

Lifestyle medicine

Fundamental Clinical Imbalances : Digestive, absorptive and microbiological
Patient Centred Factors : Mediators/Microbiome
Environmental Inputs : Microorganisms
Personal Lifestyle Factors : Not applicable
Functional Laboratory Testing : Stool
Bioactive Substances : Faecal microbiota transplant

Methodological quality

Jadad score : 1
Allocation concealment : Not applicable
Publication Type : Clinical Trial ; Journal Article

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