Department of Medicine, Stord Helse Fonna Hospital and University of Bergen, Stord 5416, Norway.
Department of Medicine, King Chulalongkorn Memorial Hospital and Center of Excellence in Neurogastroenterology and Motility, Chulalongkorn University, Bangkok 10330, Thailand.
World J Gastroenterol. 2021 Jun 14;27(22):2921-2943. doi: 10.3748/wjg.v27.i22.2921.
Irritable bowel syndrome (IBS) affects about 12% of the global population. Although IBS does not develop into a serious disease or increase mortality, it results in a considerable reduction in the quality of life. The etiology of IBS is not known, but the intestinal microbiota appears to play a pivotal role in its pathophysiology. There is no effective treatment for IBS, and so the applied treatments clinically focus on symptom relief. Fecal microbiota transplantation (FMT), an old Chinese treatment, has been applied to IBS patients in seven randomized controlled trials (RCTs). Positive effects on IBS symptoms in various degrees were obtained in four of these RCTs, while there was no effect in the remaining three. Across the seven RCTs there were marked differences in the selection processes for the donor and treated patients, the transplant dose, the route of administration, and the methods used to measure how the patients responded to FMT. The present frontier discusses these differences and proposes: (1) criteria for selecting an effective donor (superdonor); (2) selection criteria for patients that are suitable for FMT; (3) the optimal FMT dose; and (4) the route of transplant administration. FMT appears to be safe, with only mild, self-limiting side effects of abdominal pain, cramping, tenderness, diarrhea, and constipation. Although it is early to speculate about the mechanisms underlying the effects of FMT, the available data suggest that changes in the intestinal bacteria accompanied by changes in fermentation patterns and fermentation products (specifically short-chain fatty acids) play an important role in improving the IBS symptoms seen after FMT. FMT appears to be a promising treatment for IBS, but further studies are needed before it can be applied in everyday clinical practice.
肠易激综合征（IBS）影响全球约 12%的人口。虽然 IBS 不会发展成严重疾病或增加死亡率，但它会导致生活质量显著下降。IBS 的病因尚不清楚，但肠道微生物群似乎在其病理生理学中起关键作用。目前尚无有效的 IBS 治疗方法，因此临床上应用的治疗方法主要集中在缓解症状上。粪便微生物群移植（FMT）是一种古老的中国治疗方法，已在 7 项随机对照试验（RCT）中应用于 IBS 患者。这 7 项 RCT 中的 4 项研究获得了 IBS 症状在不同程度上的积极效果，而其余 3 项则没有效果。在这 7 项 RCT 中，供体和受治患者的选择过程、移植剂量、给药途径以及衡量患者对 FMT 反应的方法都存在显著差异。本前沿探讨了这些差异，并提出：（1）选择有效供体（超级供体）的标准；（2）适合 FMT 的患者选择标准；（3）最佳 FMT 剂量；以及（4）移植给药途径。FMT 似乎是安全的，只有轻微的、自限性的副作用，如腹痛、痉挛、压痛、腹泻和便秘。尽管推测 FMT 作用机制还为时过早，但现有数据表明，肠道细菌的变化伴随着发酵模式和发酵产物（特别是短链脂肪酸）的变化，在改善 FMT 后观察到的 IBS 症状方面发挥着重要作用。FMT 似乎是治疗 IBS 的一种很有前途的方法，但在将其应用于日常临床实践之前，还需要进一步的研究。
