Nearly 11% of the world’s population suffers from irritable bowel syndrome, a very debilitating disease on a daily basis. This syndrome would result from an imbalance in the intestinal microbiota, which would lead to a change in intestinal permeability and inflammatory reactions. Therefore, faecal transplantation emerged as a potential treatment. A new clinical trial confirms today that this approach is effective, including in the long term.
Irritable Bowel Syndrome (IBS), also called “functional colopathy”, is a benign disease, but it can seriously affect the quality of life. Chronic abdominal pain, transit disorders (alternating constipation and diarrhoea) and other extra-digestive symptoms (headaches, fatigue, muscle pain, etc.) punctuate the daily lives of patients. Because the origin of this syndrome is still poorly understood, there is currently no treatment to cure it.
However, studies have revealed that the microbiota of people with IBS is unbalanced: the “bad” bacteria are in excess (we speak of “intestinal dysbiosis”). Repopulating the intestines with a healthier mix of bacteria, via a fecal transplant, might help restore balance and lessen the symptoms of the disease. A team from Stord Hospital in Norway set out to test this approach in a clinical trial that began three years ago: nearly two-thirds of trial participants now report a better quality of life .
At least 77% of patients relieved following three months
A few previous clinical trials have shown that faecal microbiota transplantation results in a reduction of IBS symptoms. However, the adverse effects of this transplant and its long-term effectiveness were unknown until now; especially since previous studies on the subject only included a follow-up of a maximum of one year. This is why a Norwegian team undertook a longer follow-up, over three years, in a randomized placebo-controlled trial.
Patients with IBS who have benefited from a faecal transplant have been followed over the long term: three years following the transplant, they report that their symptoms have reduced and that they are living much better. © M. El Salhy et al.
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Patients with IBS who have benefited from a faecal transplant have been followed over the long term: three years following the transplant, they report that their symptoms have reduced and that they are living much better. © M. El Salhy et al.
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Patients with IBS who have benefited from a faecal transplant have been followed over the long term: three years following the transplant, they report that their symptoms have reduced and that they are living much better. © M. El Salhy et al.
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Patients with IBS who have benefited from a faecal transplant have been followed over the long term: three years following the transplant, they report that their symptoms have reduced and that they are living much better. © M. El Salhy et al.
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The trial started in 2019. Dr Magdy El-Salhy and her colleagues at Stord Hospital collected the faeces of a 36-year-old man. This donor was a non-smoker, in good health, taking no medications and had a BMI of 23.5 kg/m2. His mother confirmed that he was born vaginally, had been breastfed and had only been treated with antibiotics three times in his life. He regularly took food supplements rich in protein, vitamins, fiber and minerals. Its microbiota was deemed ideal for transplantation.
Stool samples from this donor were transferred into the small intestine of 87 patients with moderate to severe IBS; some received 30 g of feces, others received 60 g, while another 38 patients received a transplant of their own feces as a placebo. None of the participants knew what type of faeces had been transferred to them.
After three months, 76.9% and 89.1% of patients who received a transplant of 30 g and 60 g of donor feces, respectively, reported a reduction in symptoms, regardless of the severity of the disease. their IBS (compared to 23.6% of patients who received a placebo). These same patients also reported a significant improvement in fatigue and quality of life. Only mild gastrointestinal symptoms were reported as adverse effects, but resolved spontaneously. Three years following the transplantthe results are equally encouraging.
Symptoms still lessened following three years, in at least 65% of participants
Study participants were asked regarding their health status two years and then three years following the fecal matter transplant. ” Response rates were 26.3%, 69.1%, and 77.8% in the placebo, 30g, and 60g groups, respectively, at 2 years post-transplant, and 27.0%, 64.9% and 71.8%, respectively, 3 years following transplantation “, report the researchers in the journal Gastroenterology.
The improvement in symptoms was therefore significantly greater in the groups that received donor faeces than in the placebo group. These patients had fewer IBS symptoms and fatigue, and had a better quality of life 2 and 3 years following transplantation. The dysbiosis index (which reflects the imbalance of the microbiota) only decreased in the two groups having benefited from the treatment. By comparing the microbiota of different groups of patients, the team was able to identify 10 bacteria with significant correlations with IBS symptoms and fatigue. No long-term adverse events were recorded.
Dr. El-Sahly clarifies in an interview that people with severe IBS responded better to treatment than those with moderate symptoms and that women also responded better to transplantation than men. In addition, ten patients (5 who received 30 g and 5 who received 60 g of faeces) who relapsed following three years benefited from a new transplant (90 g): most (80%) of them they once more showed signs of improvement as early as three months.
If this study proves that this method is effective and brings lasting comfort, it is unfortunately not generalizable because of the costs it implies. Scientists hope one day to succeed in isolating beneficial bacteria from healthy donors in order to administer them to patients in the form of tablets.
