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FMT improves symptoms, QOL in IBS patients
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CHICAGO — Fecal microbiota transplantation improved symptoms and quality of life in patients with irritable bowel syndrome, according to the results of a double blind randomized controlled trial presented at Digestive Disease Week.
“It seems that FMT has a beneficial effect on symptom scores and on quality of life in IBS patients. However, this effect is also observed in the placebo group, although to a lesser extent, but this indicates that placebo controlled studies are definitely necessary in IBS patients,” Savanne Holster, PhD, of the Nutrition-Gut-Brain Interactions Research Center at Örebro University in Sweden, said during her presentation.
Holster and colleagues randomly assigned 16 patients with IBS to receive FMT via colonoscopy using either donor material or their own fecal material as placebo. The researchers assessed symptom scores and quality of life before and after the procedure.
IBS Symptom Severity Scores in patients who received donor FMT dropped significantly at 4 and 8 weeks after treatment compared with baseline (P < .01 for both), while there were no significant changes observed in the placebo group. There were also no significant differences observed in IBS-SSS between the treatment and placebo groups.
Gastrointestinal Symptom Rating Scale scores dropped significantly for both the treatment and placebo groups 2 and 4 weeks after FMT compared with baseline (P < .01 for FMT and P < .05 for placebo at both time points). There were again no significant differences observed between the treatment and placebo groups.
Further, IBS Quality of Life total scores increased significantly in the treatment group but not in the placebo group at 8 weeks (P < .01), as did three of eight SF-36 subscores. The general health subscore in particular increased significantly in the treatment group compared with placebo at 8 weeks (P < .01).
“We think that maybe the bowel cleansing or the processing of the [autologous] fecal material might have contributed to the placebo effect,” Holster said. – by Adam Leitenberger
Reference:
Holster S, et al. Abstract #430. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.
Disclosures: Holster reports no relevant financial disclosures.
Perspective
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Colleen R. Kelly, MD, FACG
Clinical trials in IBS often have notable placebo effects and generally enroll hundreds of patients. This is a really small trial, including only 16 patients. The authors don’t indicate which subtype of IBS these patients had (diarrhea, constipation or mixed); I imagine that would make a difference (ie, if they were constipated, maybe just the bowel prep helped them improve symptomatically).
Though the IBS-SSS decreased in the FMT-treated patients and not the placebo group, the GSRS-IBS score decreased for both (probably that placebo effect). The differences between these two scores in both groups were not significant.
Improvements in the quality of life index and certain subscores could be related to chance or perhaps a signal of benefit. Certainly larger clinical trials are needed to determine if FMT is effective in IBS and whether it may be more beneficial in certain subtypes or symptom patterns.Click Here to Manage Email Alerts