Sustained response to faecal microbiota transplantation

Most IBS patients who responded to fecal transplantation maintained this response after 1 year. Improvements in symptoms, quality of life, fecal bacterial profile, and short-chain fatty acids increased significantly.

Most IBS patients who responded to fecal microbiota transplantation after 3 months maintained this response at 1 year after the intervention. In this study from Norway, the improvements in symptoms and quality of life increased significantly over time. Changes in the fecal bacterial profile and short-chain fatty acids also increased over time.

A recently published trial from Norway showed that fecal microbiota transplantation is an effective and safe treatment for patients with irritable bowel syndrome (IBS) after 3 months. The current follow-up study investigated the efficacy and safety of fecal microbiota transplantation at 1 year after this intervention1.

The response to fecal microbiota transplantation was maintained at 1 year after treatment in 86.5% and 87.5% of patients who received 30 g and 60 g fecal microbiota transplantation, respectively.

In the 30 g fecal microbiota transplantation group, 21.6% of patients showed complete remission (IBS-SSS total score of ≤75) after 3 months, which increased to 32.4% at 1 year. In the 60 g-group, the percentage of patients with a complete remission increased from 27.5% after 3 months to 45% at 1 year. Abdominal symptoms, fatigue, and the quality of life were also improved at 1 year compared with 3 months after fecal transplantation.

These findings were accompanied by a significant improvement in the dysbiosis index and comprehensive changes in the fecal bacterial profile. The levels of Alistipes spp. were significantly lower in the relapsed patients at baseline than in the responders and patients in remission at 1 year after fecal microbiota transplantation. Thus, Alistipes spp. seem to play a central role in the improvements seen after fecal transplantation. Levels of Alistipes spp. could probably be used to predict the outcome of fecal microbiota transplantation. The reduction of acetic acid levels could be relevant since acetic acid has been found to induce visceral hypersensitivity in rodents.

Changes in the levels of fecal short-chain fatty acids indicated that the microbial metabolism changed from a saccharolytic to a proteolytic fermentation pattern in IBS patients at 1 year after fecal transplantation. The level of fecal acetic acid was reduced compared with baseline. Further, the clinically relapsed patients had significantly lower fatigue scores and significant changes in the bacterial profile and the levels of short-chain fatty acids compared with baseline.

The finding that fecal microbiota transplantation induced remission in about half of the patients with IBS emphasizes the role of the intestinal microbiota in the etiology of IBS.

1. El-Salhy M. Long-term effects of faecal microbiota transplantation (FMT) in patients with irritable bowel syndrome. UEG Week E-congress 2020, abstract OP059.