Department of Medicine, Stord Helse-Fonna Hospital, Stord 5416, Norway.
Genetic Analysis AS, Oslo 0485, Norway.
World J Gastroenterol. 2021 May 14;27(18):2219-2237. doi: 10.3748/wjg.v27.i18.2219.
Faecal microbiota transplantation (FMT) seems to be a promising treatment for irritable bowel syndrome (IBS) patients. In Western countries (United States and Europe), there is a female predominance in IBS. A sex difference in the response to FMT has been reported recently in IBS patients.
To investigate whether there was a sex difference in the response to FMT in the IBS patients who were included in our previous randomized controlled trial of the efficacy of FMT.
The study included 164 IBS patients who participated in our previous randomized controlled trial. These patients had moderate-to-severe IBS symptoms belonging to the IBS-D (diarrhoea-predominant), IBS-C (constipation-predominant) and IBS-M (mixed) subtypes, and had not responded to the National Institute for Health and Care Excellence (NICE)-modified diet. The belonged in three groups: placebo (own faeces), and active treated group (30-g or 60-g superdonor faeces). The patients completed the IBS severity scoring system (IBS-SSS), Fatigue Assessment Scale (FAS) and the IBS quality of life scale (IBS-QoL) questionnaires at the baseline and 2 wk, 1 mo and 3 mo after FMT. They also provided faecal samples at the baseline and 1 mo after FMT. The faecal bacteria profile and dysbiosis were determined using the 16S rRNA gene polymerase chain reaction DNA amplification covering V3-V9; probe labelling by single nucleotide extension and signal detection. The levels of short-chain fatty acids (SCFAs) were determined by gas chromatography and flame ionization.
There was no sex difference in the response to FMT either in the placebo group or active treated group. There was no difference between females and males in either the placebo group or actively treated groups in the total score on the IBS-SSS, FAS or IBS-QoL, in dysbiosis, or in the faecal bacteria or SCFA level. However, the response rate was significantly higher in females with diarrhoea-predominant (IBS-D) than that of males at 1 mo, and 3 mo after FMT. Moreover, IBS-SSS total score was significantly lower in female patients with IBS-D than that of male patients both 1 mo and 3 mo after FMT.
There was no sex difference in the response to FMT among IBS patients with moderate-to-severe symptoms who had previously not responded to NICE-modified diet. However, female patients with IBS-D respond better and have higher reduction of symptoms than males after FMT.
粪便微生物移植（FMT）似乎是治疗肠易激综合征（IBS）患者的一种有前途的方法。在西方国家（美国和欧洲），IBS 患者中女性居多。最近有报道称，IBS 患者对 FMT 的反应存在性别差异。
研究在我们之前的 FMT 疗效随机对照试验中纳入的 IBS 患者中，FMT 的反应是否存在性别差异。
该研究纳入了 164 名参加我们之前的 FMT 疗效随机对照试验的 IBS 患者。这些患者患有中重度 IBS 症状，属于 IBS-D（腹泻为主型）、IBS-C（便秘为主型）和 IBS-M（混合型）亚型，且对国家卫生与保健卓越研究所（NICE）改良饮食无反应。这些患者分为三组：安慰剂（自身粪便）和活性治疗组（30g 或 60g 超级供体粪便）。患者在 FMT 前、2 周、1 个月和 3 个月时完成 IBS 严重程度评分系统（IBS-SSS）、疲劳评估量表（FAS）和 IBS 生活质量量表（IBS-QoL）问卷，并在 FMT 前和 1 个月时提供粪便样本。使用 16S rRNA 基因聚合酶链反应 DNA 扩增覆盖 V3-V9 来确定粪便细菌谱和失调；通过单核苷酸延伸和信号检测进行探针标记。通过气相色谱和火焰电离法测定短链脂肪酸（SCFA）水平。
无论是在安慰剂组还是活性治疗组，FMT 的反应均与性别无关。在安慰剂组或活性治疗组中，女性和男性在 IBS-SSS、FAS 或 IBS-QoL 的总分、失调或粪便细菌或 SCFA 水平方面均无差异。然而，在 FMT 后 1 个月和 3 个月时，腹泻为主型（IBS-D）女性的应答率明显高于男性。此外，在 FMT 后 1 个月和 3 个月时，IBS-D 女性患者的 IBS-SSS 总分明显低于男性患者。
在先前对 NICE 改良饮食无反应的中重度症状 IBS 患者中，FMT 的反应与性别无关。然而，FMT 后，IBS-D 女性患者的反应更好，症状缓解程度更高。
