Faecal transplant helps teens with refractory IBS

For adolescents with treatment-refractory irritable bowel syndrome (IBS), faecal microbiota transplantation (FMT) is safe and beneficial, easing abdominal pain and improving health-related quality of life, according to a study presented at ESPGHAN 2023.

In the study, a total of 32 participants who were 16–21 years of age and had refractory IBS were randomly assigned to receive two faecal infusions using either healthy donor stool (donor group, n=16) or own stool (placebo, n=16). The infusions were administered at baseline and at week 6.

Taking a look at the responders (patients with ≥50-point reduction in the IBS Severity Scoring System [IBS-SSS] total score), the response rates increased with time and differed significantly between the donor and placebo groups only at the 24-week follow-up, reported lead investigators Dr Clara De Bruijn of Emma’s Children's Hospital, Amsterdam, the Netherlands. [ESPGHAN 2023, abstract G-O046]

The respective response rates in the donor and placebo groups at week 24 were 60 percent and 25 percent (p=0.048), with no significant between-group differences observed at weeks 12 and 48, De Bruijn added.

Likewise, significantly more participants in the donor group than in the placebo group achieved adequate relief from pain at week 24 (60 percent vs 25 percent; p=0.048). Meanwhile, health-related quality of life scores increased over time and were significantly better in the donor vs placebo group at weeks 12 (p=0.028), 24 (p=0.007), and 48 (p=0.011).

Microbiota composition and safety

De Bruijn noted that the gut microbiota composition was altered after the FMT. The shift in the composition before and after FMT (6, 12, 24, and 48 weeks) was more pronounced among participants who received donor stools than among those who received their own stools.

“Finally, concerning the safety of the FMT, all reported adverse events [including abdominal cramps, diarrhoea, and nausea] were mild and disappeared spontaneously within the first 3 days after FMT,” according to De Bruijn.

She and her team found no significant between-group differences in the number of patients who experienced at least one adverse event. This was true both after the first and second FMT.

Peak effect at 24 weeks

As for why the greatest clinical effects were observed at 24 weeks following the first FMT, De Bruijn stated that it is possible that such time point reflects the moment of optimal engraftment of the donor microbiota strains in the cohort.

However, she also acknowledged the presence of previous studies that showed clinical effects with a single-dose FMT at 12 weeks of follow-up.

So, the difference may be explained by the second FMT administered at week 6 in the present cohort, although the exact underlying mechanism is still unclear, De Bruijn said.

Role of healthy gut

“The exact physiology of IBS is not yet completely understood, but it is thought to be a complex interplay of factors such as psychosocial, genetic, and physiological factors such as inflammation or gastric emptying and increased rectal sensitivity,” according to De Bruijn.

“Evidence is growing for the role of gut microbiota and a better genesis of IBS. A few studies have proven that the gut microbiota from patients, adults as well as paediatric patients, differ from that from healthy controls. [Therefore], being able to modify the gut microbiota [such as by FMT] may have beneficial effects on IBS symptoms,” she noted.

The present data demonstrate the promise of FMT as a treatment strategy for refractory IBS in older children, with beneficial effects on both abdominal pain symptoms and health related quality of life, De Bruijn stated.

“It's a safe intervention with only mild and self-limiting adverse events, and the results of our trial provide complete preliminary evidence for clinical use in the future,” she added.