Follow-up Study of Fecal Microbiota Transplantation (FMT) for the Treatment of Refractory Irritable Bowel Syndrome (IBS)

Abstract

Purpose: The etiology of IBS is multifactorial, with intestinal microbiota being increasingly implicated in its pathogenesis. FMT restores fecal microbiome diversity in patients with refractory C. difficile infection, and has impressive cure rates. We postulated FMT treatment of refractory IBS might result in similar benefit. Methods: A follow-up study was conducted of all patients who had FMT for refractory IBS after interventions of dietary modification, probiotics, antibiotics, and/or anti-depressants had failed. A 41-point questionnaire assessed demographic and pre- and post-FMT data, quantifying severity of abdominal pain, bloating, flatus, and dyspepsia (severe=3, moderate=2, mild=1, none=0); diarrhea (nl=0, 1-2 BM/day>nl= 1, 3-4 BM/day>nl=2, >4 BM/day>nl= 3), constipation (nl=0, >4 BM/wk=1, 2-3 BM/wk=2, <2 BM/wk=3), and global well-being (poor=3, acceptable=2, good=1). Results: Thirteen of 15 eligible patients (54% women) completed the study. Average age was 45 years (range: 23-75 years). Patients had IBS for an average of 73 months before FMT (range: 12-180 months). Average time from FMT to data collection was 11 months (range: 6-18 months). Nine patients (64%) had IBS-D, three (21%) had IBS-C and one had IBS-M. Eleven patients (79%) had FMT once, one patient twice, and one patient three times. Eleven patients (79%) had abdominal pain before FMT (mean score: 2.55); after FMT, resolution, improvement, or no change was reported in three (27%), five (46%), and three (27%) patients, respectively (mean score: 1.45). Twelve patients (80%) complained of bloating before FMT (mean score: 2.25), which resolved, improved, or did not change in two (17%), four (33%), and six (50%) patients, respectively (mean score: 1.42). Before FMT, 12 patients (92%) had flatus (mean score: 2.4), and after FMT, resolution, improvement, no change, or worsening of flatus was reported in one (8%), four (33%), six (50%), and one (8%) patient, respectively (mean score: 1.75). Six patients (43%) had dyspepsia before FMT (mean score: 1.83) and two patients (33.3%) reported resolution, two (33.3%) noted improvement, and two (33.3%) had no change after FMT (mean score: 1.17). In nine IBS-D patients, pre-FMT score was 1.89 and post-FMT mean score was 0.78. Of the three patients with IBS-C, mean pre-FMT score was 1.33 and post-FMT mean score was 0.33. One patient had IBS-M and had improved diarrhea and constipation after FMT. Three patients (23%) reported no improvement. Before FMT, global well-being was reported as “good” in zero patients, “acceptable” in four patients (30%), and “poor” in nine patients (69%) (mean score: 2.69). After FMT, global well-being was “good” in three patients (23%), “acceptable” in six (46%) and “poor” in four (30%) (mean score: 1.92). Conclusion: FMT resolved or improved symptoms in 70% of our patients with refractory IBS, including abdominal pain (72%), bowel habit (69%), dyspepsia (67%), bloating (50%), and flatus (42%). FMT also resulted in improved quality of life (46%).