FMT for IBS, Does it Work? A Summary of the Science

There is no clear evidence that FMT is a go-to therapy for IBS … yet.

Dr. Michael Rusio: If you have irritable bowel syndrome (IBS) should you undergo fecal microbiota transplant therapy – FMT? Hi. This is Dr. Ruscio, and let’s discuss this question. This is certainly something that patients, especially if they’ve tried a few different dietary changes or use probiotics and still aren’t seeing improvements in their IBS, in their abdominal pain, in their constipation, diarrhea, gas or bloating, are wondering. Could a fecal transplant help? Let’s start with what FMT is, in case you have not heard of it. FMT is essentially taking the stool from a healthy donor and then transplanting it into the colon, either through a colonic administration or sometimes, through a tube down the nose or the throat into the intestines. The thinking mechanism here is that the tremendous amount of bacteria contained in the healthy donor stool functions like a super probiotic that contains a thousand and some odd bacteria and also fungus, and this can help to literally recolonize the host, in this case, a sick individual, with the healthy microbiota of a healthier donor.

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Efficacy of FMT with Irritable Bowel Syndrome (IBS)

And there is great evidence for this being lifesaving in a chronic Clostridium difficile infection. And there’s some emerging evidence that’s hopeful and promising for inflammatory bowel disease, Crohn’s and ulcerative colitis. So it begs the question, could this also be helpful for IBS? The data here are unclear. There is some data that suggest that FMT can help IBS. There are other data showing that FMT cannot help IBS, and I’ll share some of these juxtaposing opinions with you in a moment. Part of the reason this disagreement may occur is because there is no consensus on what is the best method of administration. Should we do this with fresh stool via an animal-like setup? Should we freeze the stool into these capsules that can be taken orally or use a tube that goes down the nose into the small intestine? How frequently should this be administered? Can it be done once? Does it need to be done serially? Because of this, even though there is some positive data, I think it’s important to bridle the enthusiasm for how quickly IBS patients reach for FMT.

What the Studies Showed in Clinical Trials

I have seen IBS patients here in the clinic that have gone off to do FMT, and some have been helped but I would say, at least to my best recollection, that more patients with various types of IBS seem to be not helped or only minimally helped from FMT. Again, I think this is something that could be helpful, but we may have more to learn. But here are the conclusions from two high-level analyses, systematic reviews with meta-analysis, essentially saying opposing things, and I’ll put the first abstract up here on the screen from the Journal of Elementary Pharmacology and Therapeutics, A Systematic Review.

Essentially, they’re concluding fresh or frozen donors delivered via colonoscopy or nasal digital tube may be beneficial in IBS, but larger, more rigorously controlled trials on FMT and IBS are needed. So this is suggested that people with IBS may be aided by FMT. However, going to abstract number two, from the American Journal of Gastroenterology, current evidence from RCTs, or randomized controlled trials, does not suggest a benefit of FMT for global IBS symptoms. There remain questions regarding the efficacy of FMT and IBS as well as the lack of clear explanations on the discrepant results among RCTs in subgroup analyses. So what we’re seeing here is there may or may not be a benefit. Essentially, more research is needed.

So What Should You Do?

My recommendation would be to exhaust all of the other available therapies before utilizing FMT. Now I should mention, oftentimes, a patient will have tried a diet or two, tried some probiotics, potentially tried an antibiotic, antimicrobials, and seen a flicker of improvement. And what I’ve noticed is a common oversight for patients is they don’t have an overarching process to organize how all these different therapies could be used in sequence and in conjunction with one another. And in many cases, the difference between success and failure is not just using a diet or a probiotic or an antibiotic or antimicrobial, but rather having a process through which you work. And this is exactly what I lay out in Healthy Gut, Healthy You. There are essentially eight steps that can all be somewhat tweaking personalized to the individual along each step that allows you to build a progressive supportive program for your gut and to cultivate the healthiest ecosystem and environment in the gut microbiota, thus allowing and favoring the healthy bacteria to grow.

So I want to be careful too to draw that clear distinction that if you’ve tried some of the stuff that’s discussed in gut therapies but you haven’t done it with an overarching map and plan, then that very well may be the difference between success and failure. And I don’t say that lightly. We’ve documented here on the website a number of patients who have been to other doctors, in some cases, five other doctors, read other books and they only saw the results they were looking to obtain after going through the Healthy Gut, Healthy You protocol. And I think that’s because I wrote the protocol not to be kind of easy, here’s something that can help, which is all fine and good, but rather here is a real game plan and map to walk you through from A to Z, a comprehensive approach for improving your gut health. I would start there, or with a competent GI clinician. Unfortunately, the new and the novel sometimes distract us from working through the tried and true.

Episode Wrap-Up

So I think there’s a place for FMT and IBS potentially, but we’re still very early. There are still some major discrepancies in the data like we just discussed. So again, I would start first by going through a well-articulated plan for improving your gut health, exhaust all the available options, and then leave FMT as a last resort. And please, if you do FMT, work with a professional.

Okay. This is Dr. Ruscio, and I hope this helps you get healthy and get back to your life.