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Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21(st) century

Irritable bowel syndrome (IBS) affects about 12% of the global population. Although IBS does not develop into a serious disease or increase mortality, it results in a considerable reduction in the quality of life. The etiology of IBS is not known, but the intestinal microbiota appears to play a pivo...

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Autores principales: El-Salhy, Magdy, Patcharatrakul, Tanisa, Gonlachanvit, Sutep
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192290/
https://www.ncbi.nlm.nih.gov/pubmed/34168399
http://dx.doi.org/10.3748/wjg.v27.i22.2921
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author El-Salhy, Magdy
Patcharatrakul, Tanisa
Gonlachanvit, Sutep
author_facet El-Salhy, Magdy
Patcharatrakul, Tanisa
Gonlachanvit, Sutep
author_sort El-Salhy, Magdy
collection PubMed
description Irritable bowel syndrome (IBS) affects about 12% of the global population. Although IBS does not develop into a serious disease or increase mortality, it results in a considerable reduction in the quality of life. The etiology of IBS is not known, but the intestinal microbiota appears to play a pivotal role in its pathophysiology. There is no effective treatment for IBS, and so the applied treatments clinically focus on symptom relief. Fecal microbiota transplantation (FMT), an old Chinese treatment, has been applied to IBS patients in seven randomized controlled trials (RCTs). Positive effects on IBS symptoms in various degrees were obtained in four of these RCTs, while there was no effect in the remaining three. Across the seven RCTs there were marked differences in the selection processes for the donor and treated patients, the transplant dose, the route of administration, and the methods used to measure how the patients responded to FMT. The present frontier discusses these differences and proposes: (1) criteria for selecting an effective donor (superdonor); (2) selection criteria for patients that are suitable for FMT; (3) the optimal FMT dose; and (4) the route of transplant administration. FMT appears to be safe, with only mild, self-limiting side effects of abdominal pain, cramping, tenderness, diarrhea, and constipation. Although it is early to speculate about the mechanisms underlying the effects of FMT, the available data suggest that changes in the intestinal bacteria accompanied by changes in fermentation patterns and fermentation products (specifically short-chain fatty acids) play an important role in improving the IBS symptoms seen after FMT. FMT appears to be a promising treatment for IBS, but further studies are needed before it can be applied in everyday clinical practice.
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spelling pubmed-81922902021-06-23 Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21(st) century El-Salhy, Magdy Patcharatrakul, Tanisa Gonlachanvit, Sutep World J Gastroenterol Frontier Irritable bowel syndrome (IBS) affects about 12% of the global population. Although IBS does not develop into a serious disease or increase mortality, it results in a considerable reduction in the quality of life. The etiology of IBS is not known, but the intestinal microbiota appears to play a pivotal role in its pathophysiology. There is no effective treatment for IBS, and so the applied treatments clinically focus on symptom relief. Fecal microbiota transplantation (FMT), an old Chinese treatment, has been applied to IBS patients in seven randomized controlled trials (RCTs). Positive effects on IBS symptoms in various degrees were obtained in four of these RCTs, while there was no effect in the remaining three. Across the seven RCTs there were marked differences in the selection processes for the donor and treated patients, the transplant dose, the route of administration, and the methods used to measure how the patients responded to FMT. The present frontier discusses these differences and proposes: (1) criteria for selecting an effective donor (superdonor); (2) selection criteria for patients that are suitable for FMT; (3) the optimal FMT dose; and (4) the route of transplant administration. FMT appears to be safe, with only mild, self-limiting side effects of abdominal pain, cramping, tenderness, diarrhea, and constipation. Although it is early to speculate about the mechanisms underlying the effects of FMT, the available data suggest that changes in the intestinal bacteria accompanied by changes in fermentation patterns and fermentation products (specifically short-chain fatty acids) play an important role in improving the IBS symptoms seen after FMT. FMT appears to be a promising treatment for IBS, but further studies are needed before it can be applied in everyday clinical practice. Baishideng Publishing Group Inc 2021-06-14 2021-06-14 /pmc/articles/PMC8192290/ /pubmed/34168399 http://dx.doi.org/10.3748/wjg.v27.i22.2921 Text en ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Frontier
El-Salhy, Magdy
Patcharatrakul, Tanisa
Gonlachanvit, Sutep
Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21(st) century
title Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21(st) century
title_full Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21(st) century
title_fullStr Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21(st) century
title_full_unstemmed Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21(st) century
title_short Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21(st) century
title_sort fecal microbiota transplantation for irritable bowel syndrome: an intervention for the 21(st) century
topic Frontier
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8192290/
https://www.ncbi.nlm.nih.gov/pubmed/34168399
http://dx.doi.org/10.3748/wjg.v27.i22.2921
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