Patient-Oriented Evidence That Matters

Fecal Microbiota Transplant Effective for Irritable Bowel Syndrome


Am Fam Physician. 2020 Sep 15;102(6):377.

Clinical Question

Does a fecal microbiota transplant safely improve symptoms in patients with irritable bowel syndrome?

Bottom Line

This is the largest and best study to date of fecal microbiota transplant for irritable bowel syndrome (IBS)—with impressive results. The authors argue that the quality of donor stool is an important factor and may explain the differences in results (one previous study had positive findings, the other did not). Although findings persisted and even improved between one and three months posttransplant, it is unclear how long the benefits will persist. (Level of Evidence = 1b)


When we call something a syndrome, that often means we do not know what causes it or how to treat it. It seems like bacteria in the gut may have something to do with IBS. These authors identified 200 Norwegian patients who met the Rome IV criteria for IBS and who had no red flags for inflammatory bowel disease or malignancy. A 12-week course of dietary manipulation therapy had been ineffective. At baseline, a stool sample was taken. After excluding 35 patients, largely because of withdrawal of consent or declining participation, the authors randomized the remaining 165 patients to one of three groups: placebo (transplant with 30 g of their own stool), 30-g fecal microbiota transplant, or 60-g fecal microbiota transplant. The fecal microbiota transplants were administered via upper endoscopy. The average age of participants was 40 years, 81% were women, and most had constipation- or diarrhea-predominant IBS rather than mixed. The donor was a healthy, nonsmoking male who had received only three courses of antibiotics in his life and ate a healthy diet. A variety of IBS-specific scores were measured, and a response was defined as a reduction in the IBS Severity Scoring System score of at least 50 points at three months' follow-up. This occurred in 24% of the patients who received placebo, 77% who received the 30-g fecal microbiota transplant, and 89% who received

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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