Meeting NewsPerspective

Fecal transplant alters gut microbiome in IBS patients

WASHINGTON — Fecal microbiota transplantation altered the gut microbiota of patients with irritable bowel syndrome, but it was not superior to placebo for improving symptoms in a study presented at Digestive Disease Week.

Bobby Lo, MD, of Hvidovre University Hospital in Denmark, and colleagues wanted to investigate the potential of FMT as a treatment for IBS because the condition has been linked to intestinal dysbiosis.

“It’s been hypothesized that gut microbiota is partly the root for many diseases,” Lo said during his presentation.

In a multicenter, double-blind, placebo-controlled study, Lo and colleagues analyzed data from 45 patients with moderate-to-severe IBS. They split the patients into two groups that received either FMT (n = 22) or placebo (n = 23) capsules for 12 days, and followed the patients for six months.

Lo said the FMT group had a higher biodiversity after treatment and closely resembled the biodiversity of the FMT donors, whereas the patients in the placebo group had a biodiversity that was indistinguishable from their pre-treatment state.

“These are really good results,” Lo said. “We’ve managed to change the biodiversity of these IBS patients even after six months.”

While patients in the FMT group showed symptom improvement throughout the study, researchers found that patients in the placebo group experienced greater symptom relief based on the IBS Symptom Severity Score, as well as in IBS quality of life data. There was also no difference among IBS subtype groups, Lo said.

Although the study showed that FMT did not help patients improve clinical symptoms of IBS, Lo said the results might have been affected by two key steps in pre-treatment. Both groups had to go through a bowel cleansing before the treatment, and the study used a mixed batch of fecal transplant taken from four healthy donors.

“Could the FMT have counteracted the positive effect of the bowel cleansing,” Lo theorized. “Did FMT reintroduce harmful microbes that were lost due to the bowel cleanse?”

Lo and colleagues believe that more research with different study designs are needed to further investigate the role of FMT in IBS.

Healio Gastroenterology and Liver Disease also reported on a similar study of FMT in IBS that was presented during the AGA Presidential Plenary at DDW. – by Alex Young

Reference:

Halkjær S, et al. Abstract 914. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosures: Lo reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.

WASHINGTON — Fecal microbiota transplantation altered the gut microbiota of patients with irritable bowel syndrome, but it was not superior to placebo for improving symptoms in a study presented at Digestive Disease Week.

Bobby Lo, MD, of Hvidovre University Hospital in Denmark, and colleagues wanted to investigate the potential of FMT as a treatment for IBS because the condition has been linked to intestinal dysbiosis.

“It’s been hypothesized that gut microbiota is partly the root for many diseases,” Lo said during his presentation.

In a multicenter, double-blind, placebo-controlled study, Lo and colleagues analyzed data from 45 patients with moderate-to-severe IBS. They split the patients into two groups that received either FMT (n = 22) or placebo (n = 23) capsules for 12 days, and followed the patients for six months.

Lo said the FMT group had a higher biodiversity after treatment and closely resembled the biodiversity of the FMT donors, whereas the patients in the placebo group had a biodiversity that was indistinguishable from their pre-treatment state.

“These are really good results,” Lo said. “We’ve managed to change the biodiversity of these IBS patients even after six months.”

While patients in the FMT group showed symptom improvement throughout the study, researchers found that patients in the placebo group experienced greater symptom relief based on the IBS Symptom Severity Score, as well as in IBS quality of life data. There was also no difference among IBS subtype groups, Lo said.

Although the study showed that FMT did not help patients improve clinical symptoms of IBS, Lo said the results might have been affected by two key steps in pre-treatment. Both groups had to go through a bowel cleansing before the treatment, and the study used a mixed batch of fecal transplant taken from four healthy donors.

“Could the FMT have counteracted the positive effect of the bowel cleansing,” Lo theorized. “Did FMT reintroduce harmful microbes that were lost due to the bowel cleanse?”

Lo and colleagues believe that more research with different study designs are needed to further investigate the role of FMT in IBS.

Healio Gastroenterology and Liver Disease also reported on a similar study of FMT in IBS that was presented during the AGA Presidential Plenary at DDW. – by Alex Young

Reference:

Halkjær S, et al. Abstract 914. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosures: Lo reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.

    Perspective
    Jessica R. Allegretti

    Jessica R. Allegretti

    Overall, there were three trials presented at DDW that looked at FMT for the treatment of IBS; two of these were negative studies, leaving a big question regarding the utility of FMT for this series of diseases and also the role gut bacteria play in the pathogenesis of IBS.

    In this study, the authors focused on microbial engraftment as the outcome of interest. The patients who underwent FMT did have an overall increase in diversity, but this change had no effect on symptoms. In fact, the patients in the placebo arm showed more improvement. It begs the question, what role are bacteria playing in this disease? Are more bacteria worse or harmful?  The authors raise an interesting point to consider: the positive intervention actually could be the bowel prep as all the patients in the placebo arm received the bowel prep and many improved.

    • Jessica R. Allegretti, MD, MPH
    • Attending gastroenterologist Crohn's and Colitis Center Assistant professor of medicine Division of gastroenterology, hepatology and endoscopy Brigham and Women's Hospital

    Disclosures: Allegretti reports a financial relationship with Finch Therapeutics.

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