Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2023; 29(20): 3185-3202
Published online May 28, 2023. doi: 10.3748/wjg.v29.i20.3185
Fecal microbiota transplantation for the treatment of irritable bowel syndrome: A systematic review and meta-analysis
Sofie Ingdam Halkjær, Bobby Lo, Frederik Cold, Alice Højer Christensen, Savanne Holster, Julia König, Robert Jan Brummer, Olga C Aroniadis, Perttu Lahtinen, Tom Holvoet, Lise Lotte Gluud, Andreas Munk Petersen
Sofie Ingdam Halkjær, Bobby Lo, Frederik Cold, Lise Lotte Gluud, Andreas Munk Petersen, Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
Sofie Ingdam Halkjær, Bobby Lo, Frederik Cold, Andreas Munk Petersen, Copenhagen IBD Center, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
Alice Højer Christensen, Department of Gastroenterology, Aleris-Hamlet Hospitals Copenhagen, Søborg 2860, Denmark
Savanne Holster, Julia König, Robert Jan Brummer, Nutrition-Gut-Brain Interactions Research Centre, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro 70362, Sweden
Olga C Aroniadis, Department of Internal Medicine, Division of Gastroenterology, Renaissance School of Medicine, Stony Brook University Hospital, New York, NY 11794-8434, United States
Perttu Lahtinen, Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti 15850, Finland
Perttu Lahtinen, Department of Medicine, University of Helsinki, Helsinki 00014, Finland
Tom Holvoet, Department of Gastroenterology, University Hospital Ghent, Ghent 9000, Belgium
Lise Lotte Gluud, Andreas Munk Petersen, Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
Andreas Munk Petersen, Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
Author contributions: Halkjær SI, Gluud LL and Petersen AM conceived the review; Halkjær SI, Lo B, Cold F, Højer Christensen A, Gluud LL and Petersen AM wrote the protocol for the review; Halkjær SI and Lo B searched and selected studies for the review; Halkjær SI, Lo B, Holster S, König J, Brummer RJ, Aroniadis OC, Holvoet T and Lahtinen P collected data for the review; Lo B, Cold F and Gluud LL assessed the risk of bias in the studies used; Halkjær SI, Lo B, Gluud LL and Petersen AM assessed the certainty of the evidence; Halkjær SI and Lo B interpreted the data; Halkjær SI and Lo B wrote the review; Halkjær SI, Lo B, Cold F, Højer Christensen A, Petersen AM, Holster S, König J, Brummer RJ, Aroniadis OC, Holvoet T, Lahtinen P and Gluud LL commented on the review. All authors have read and approved the final manuscript. None of the authors have extracted data from, or assessed the risk of bias in, trials they carried out themselves.
Conflict-of-interest statement: None of the authors report relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sofie Ingdam Halkjær, MSc, PhD, Senior Researcher, Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Hvidovre 2650, Denmark. sofie.ingdam.halkjaer@regionh.dk
Received: February 22, 2023
Peer-review started: February 22, 2023
First decision: March 18, 2023
Revised: April 6, 2023
Accepted: April 18, 2023
Article in press: April 18, 2023
Published online: May 28, 2023
Processing time: 92 Days and 23.7 Hours
ARTICLE HIGHLIGHTS
Research background

Irritable bowel syndrome (IBS) is a widespread gastrointestinal disorder accompanied by chronic abdominal pain and altered bowel habits. Gut microbiota disturbances have been linked to the pathophysiology of IBS, with fecal microbiota transplantation (FMT) emerging as a potential treatment strategy.

Research motivation

Manipulating gut microbiota composition via FMT could offer a promising avenue for IBS treatment, warranting further investigation into its efficacy and safety.

Research objectives

This review and meta-analysis aimed to evaluate the effectiveness and safety of FMT for treating IBS.

Research methods

A comprehensive search of Cochrane Central, MEDLINE, EMBASE, and Web of Science to identify randomised controlled trials (RCT) comparing FMT to placebo or autologous FMT in IBS patients. Primary outcome was improvement of symptoms, while secondary outcomes were quality-of-life scores and adverse events.

Research results

Our analysis incorporated data from eight RCTs with 484 participants. FMT did not result in significant improvement of symptoms when compared to placebo after three months, and no significant improvement in quality of life was observed. Subgroup analysis indicated that endoscopic FMT delivery led to symptom improvement, whereas FMT capsules did not. FMT was found to be safe.

Research conclusions

This systematic review and meta-analysis do not support FMT as a treatment for IBS outside of clinical trials. Nevertheless, FMT was found to be safe.

Research perspectives

Large-scale, RCTs are needed to confirm or refute these findings. Investigating the potential significance of combining different FMT delivery routes for strain engraftment could provide a more comprehensive understanding of microbial engraftment dynamics in IBS patients.