Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Am J Gastroenterol. 2019 Jul;114(7):1043-1050. doi: 10.14309/ajg.0000000000000198.
Irritable bowel syndrome (IBS) is a common gastrointestinal condition with a heterogeneous pathophysiology. An altered gut microbiome has been identified in some IBS patients, and fecal microbiota transplantation (FMT) has been suggested to treat IBS. We performed meta-analyses and systematic review of available randomized controlled trials (RCTs) to evaluate the efficacy of FMT in IBS.
We performed a systematic literature search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science. Selection criteria included RCTs of FMT vs placebo using FMT excipients or autologous FMT in IBS. Meta-analyses were conducted to evaluate the summary relative risk (RR) and 95% confidence intervals (CIs) of combined studies for primary outcome of improvement in global IBS symptoms as measured by accepted integrative symptom questionnaires or dichotomous responses to questions of overall symptom improvement.
Among 742 citations identified, 7 were deemed to be potentially relevant, of which 4 studies involving 254 participants met eligibility. No significant difference in global improvement of IBS symptoms was observed at 12 weeks in FMT vs placebo (RR = 0.93; 95% CI 0.48-1.79). Heterogeneity among studies was significant (I = 79%). Subgroup analyses revealed benefits of single-dose FMT using colonoscopy and nasojejunal tubes in comparison with autologous FMT for placebo treatment (number needed to treat = 5, RR = 1.59; 95% CI 1.06-2.39; I = 0%) and a reduction in likelihood of improvement of multiple-dose capsule FMT RCTs (number needed to harm = 3, RR = 0.54; 95% CI 0.34-0.85; I = 13%). Placebo response was 33.7% in nonoral FMT RCTs and 67.8% in capsule FMT RCTs. The Grading of Recommendations Assessment, Development and Evaluation quality of the body of evidence was very low.
Current evidence from RCTs does not suggest a benefit of FMT for global IBS symptoms. There remain questions regarding the efficacy of FMT in IBS as well as the lack of a clean explanation on the discrepant results among RCTs in subgroup analyses.
肠易激综合征（IBS）是一种常见的胃肠道疾病，其病理生理学具有异质性。一些 IBS 患者的肠道微生物群发生了改变，粪便微生物群移植（FMT）已被建议用于治疗 IBS。我们对现有的随机对照试验（RCT）进行了荟萃分析和系统评价，以评估 FMT 在 IBS 中的疗效。
我们对 MEDLINE、EMBASE、Cochrane 对照试验中心注册库和 Web of Science 进行了系统的文献检索。选择标准包括使用 FMT 赋形剂或自体 FMT 治疗 IBS 的 RCT，比较 FMT 与安慰剂。对汇总研究进行荟萃分析，以评估综合症状改善的主要结局（采用公认的综合症状问卷或对整体症状改善的问题进行二分类应答）的综合相对风险（RR）和 95%置信区间（CI）。
在 742 条引用文献中，有 7 条被认为可能相关，其中 4 项研究涉及 254 名参与者符合入选标准。在 12 周时，FMT 与安慰剂相比，IBS 症状的整体改善无显著差异（RR=0.93；95%CI 0.48-1.79）。研究之间的异质性非常显著（I=79%）。亚组分析显示，与自体 FMT 相比，结肠镜和鼻空肠管给予单剂量 FMT 对安慰剂治疗的益处更大（需要治疗的人数=5，RR=1.59；95%CI 1.06-2.39；I=0%），并且减少了多剂量胶囊 FMT RCT 中改善的可能性（需要危害的人数=3，RR=0.54；95%CI 0.34-0.85；I=13%）。非口服 FMT RCT 中的安慰剂反应为 33.7%，胶囊 FMT RCT 中的安慰剂反应为 67.8%。证据体的推荐评估、制定与评价质量等级为极低。
目前 RCT 的证据并不表明 FMT 对 IBS 的整体症状有获益。关于 FMT 在 IBS 中的疗效仍存在问题，并且亚组分析中 RCT 之间的结果差异也没有明确的解释。
