Does Fecal Microbiota Transplantation Improve Disease Severity in Irritable Bowel Syndrome Patients Compared to Placebo?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not fecal microbiota transplantation improves disease severity in irritable bowel syndrome patients compared to placebo. STUDY DESIGN: A systematic review of three double-blind, randomized, placebo-controlled trials published since 2014. DATA SOURCES: Articles found using PubMed, Cochrane Library, AMED and CINAHL Plus and selected based on their relevance to the clinical question. All sources published in peer reviewed journals in English. OUTCOME(S) MEASURED: Disease severity of irritable bowel syndrome measured in all three studies using the IBS-severity scoring system (IBS-SSS). RESULTS: The primary endpoint evaluated in all studies was improvement in symptom severity at 3 months after intervention quantified using IBS-SSS. Halkjær et al3 found a decrease in IBS-SSS of 52.45 ± 97.72 in the FMT group and a decrease in IBS-SSS of 125.71 ± 90.85 in the placebo group (p=0.012). Johnsen et al1 found 65% of FMT recipients vs. 43% of placebo recipients showed a decrease in IBS-SSS of \u3e 75 points at 3 months after intervention (p=0.049). Aroniadis et al5 found a decrease in IBS-SSS of 221 ± 105 in the FMT group and a decrease of 236 ± 64 in the placebo group (p=0.65). CONCLUSIONS: Johnsen et al1 was the only study to demonstrate a statistically significant difference between the two groups in favor of FMT over placebo. Halkjær et al3 and Aroniadis et al5 reported a decrease in symptoms among both FMT and placebo groups with Halkjær et al3 finding a statistically significant difference in favor of placebo while Aroniadis et al5 finding no statistical significance between the two groups. These 3 studies show conflicting evidence for the use of FMT in IBS patients although overall it does not appear FMT improves disease severity in IBS patients enough to justify the risk associated with FMT for a non-lethal disease