Fecal Microbiota Transplantation

Treatment of Gastrointestinal Diseases: Irritable Bowel Syndrome and Chronic Constipation

Postinfectious IBS has been reported in up to 30% of patients with acute gastroenteritis, suggesting that the pathogenesis of IBS may be intimately linked to an altered intestinal microbiota.^[47–49] The composition of the intestinal microbiota in patients with IBS has not been extensively studied, however, patients with constipation-predominant IBS have been shown to increase population of sulphate-reducing bacteria compared with healthy controls.^[50] Probiotics can restore the intestinal microbiota in patients with IBS^[49,51] and result in improvement of postinfectious IBS in animal models;^[11] FMT, however, may prove more beneficial, as donated feces, in a sense, are the ultimate human probiotic.

In a case series of 55 patients with IBS and IBD treated with FMT, cure was reported in 20 (36%), decreased symptoms in nine (16%) and no response in 26 (47%) patients.^[6] In another series, 45 patients with chronic constipation were treated with colonoscopic FMT and subsequent fecal enema infusions, 89% of whom (40 of 45 patients) reported relief in defecation, bloating and abdominal pain immediately after the procedure.^[52] Normal defecation, without laxative use, persisted in 18 of 30 patients (60%) contacted 9–19 months later.^[52]