Irritable Bowel Syndrome (IBS) is a condition that affects around 15% of people globally. Though the condition is widespread, only a small portion of people with IBS exhibit severe, life-disrupting symptoms. The greatest frustration of having IBS is its lack of cure, or even a reliable treatment to help alleviate symptoms.
Fecal Microbiota Transplants (FMT) are in the beginning stages of study for its use in treating IBS. In this article we will cover everything you need to know about FMT and its effectiveness for IBS.
- Overview of IBS: what it is, causes, and symptoms
- IBS and the microbiome
- How FMT can be used to treat IBS
- How effective is FMT for IBS?
- Emerging studies on FMT for treating IBS
- Where can I get an FMT?
- More on IBS, FMT and managing your bowels
Overview of IBS: what it is, causes, and symptoms
If you need a quick summary of what IBS is, or need to know more about it to determine if you have it, all of your questions can be answered below. If you’re already familiar with it, jump down to learn about the connection between IBS and the microbiome.
What is IBS?
IBS is characterized by inflammation of the large intestine, generally causing diarrhea or constipation. The way and degree to which IBS affects the large intestine can vary from person to person. Irritants of the condition can also vary from person to person, though there are many common causes.
What are the symptoms of IBS?
Irritable Bowel Syndrome symptoms present themselves in a variety of ways: some sufferers experience diarrhea, while others may have constipation. It’s severity also ranges – for some it’s controllable by diet, while others need medication, or find no relief to symptoms, even with attempted treatments.
Though symptoms vary, there are common ones:
- Abdominal cramping or bloating – can typically be relieved, at least partially, by passing a bowel movement
- Excess gas
- Diarrhea or constipation — sometimes both in alternation
- Mucus in the stool
You should see your doctor if you present these more severe and less common symptoms of IBS:
- Weight loss
- Persistent diarrhea
- Blood in stool
- Unexplained vomiting
- Trouble swallowing
- Pain that is persistent and not relieved by passing gas or a bowel movement
Each person with IBS can present these symptoms to different degrees and in different combinations. As with the symptoms of IBS, there is also variance in the causes and triggers of IBS.
What causes IBS?
The exact cause of Irritable Bowel Syndrome isn’t currently known, however there are many factors that seem to play a role. Those factors include intestinal muscle contractions, the nervous system, intestinal inflammation, severe gut infections such as C Diff, and alterations in gut bacteria.
There are also some known risk factors for developing IBS:
- Being young – IBS is most frequent in people under 50
- Being female – IBS occurrences are higher among women
- Family history – Genes may predispose someone to IBS, as well as family’s shared environment
- Existing mental health problems – Anxiety, depression, and other mental health illnesses have strong associations with IBS and other GI issues.
Triggers of IBS
In many cases, IBS symptoms are largely manageable by avoiding some of the common triggers, as well as the triggers that are unique to each person’s body. Some of the most common triggers noted by medical professionals include:
- Food – Many people opt to be on specialized diets to prevent IBS bouts.
- Stress – Many people with IBS experience an increase in symptoms in times of stress. Meditation and other mindfulness techniques can be helpful for people with the condition.
- Hormones – Specifically in women; women tend to have more frequent symptoms of IBS during and around their menstrual period.
Though many find that the symptoms of IBS are avoidable through avoidance of triggers, there are some cases that require further care and treatment.
Common IBS treatments and therapies
IBS treatment depends of the severity of each case. Many people’s symptoms are onset by specific triggers, like the ones listed above. For many, avoiding those triggers is enough to alleviate pain and treat symptoms. More severe cases may be treated with restrictive diets or medication.
Though diets and medication can help with the management of an irritable bowel, they don’t always work for each person. Alternative new treatments for IBS like FMT are focussing on the microbiome’s influence on the bowel. Fecal transplants are currently being studied as a new IBS treatment for some severe and persistent cases of irritable bowel.
Many of these attempts to alleviate symptoms are natural cures for IBS, but unfortunately, don’t address the connection between the microbiome and IBS.
IBS and the microbiome
Recent research has connected IBS to the microbiome. Scientists believe that dysbiosis and other microbial unbalances in the gut microbiomes of those with IBS may be a leading factor in the syndrome.But what exactly is the microbiome, and how do the two things connect to one another?
What is the microbiome, gut flora, microbiota, and healthy gut bacteria?
The microbiome includes all the microbial communities that live within our bodies. These microbial communities are made up of millions of bacteria, protozoa, viruses and fungi which live in our ears, eyes, nose, gut, mouth, and on our skin.
Each one of these microbiomes is hugely impactful to their encompassing environment. As is the case of IBS, the gut microbiome has been found to be connected with symptoms of the syndrome.
How the microbiome is associated with IBS
Scientists believe that the symptoms of IBS are associated with the microbiome, specifically a bacterial imbalance in the gut. An analysis of data supports a widespread difference in the gut contents of those with and without IBS, which leads to a connection to gut microbiome imbalance.
This difference in microbial makeup supports a theory that FMT might relieve the symptoms in people with Irritable Bowel Syndrome.
How FMT can be used to treat IBS
The effectiveness of an IBS Fecal Transplant is still under investigation. What is known now is that there is a connection between the microbiome and IBS. FMT is increasingly being studied as an option for other microbiome-related illnesses, so it is seems like it could be the best treatment for IBS.
What are fecal transplants?
Fecal transplants are a medical procedure where stool is taken from a healthy donor and implanted into the gut of a sick recipient. The procedure targets the gut microbiome by providing healthy bacteria to fight off bad bacteria that has overtaken the gut of a sick patient.
How does FMT treat IBS
FMT is used to treat an unbalanced gut microbiome. Research points to an unbalanced gut microbiome as a cause of IBS symptoms. By treating the unbalance, the hope is that FMT will return the microbiome of IBS sufferers to a balanced, healthy state, and in turn, relieve IBS symptoms.
The early results of using FMT for IBS have been promising, solidifying theories that there is a microbiome-IBS connection. Though because IBS seems to be related to a sort of generalized long-term microbiome difference in those with the syndrome, the treatment may be only effective as symptom relief, rather than an IBS cure. The reasoning is that the microbiome is very difficult to change; it can be temporarily altered by introducing different bacteria, but for the most part, the microbiome remains unchanged from the end of its development onward.
Potential risks and side effects of FMT
The risks associated with FMT are few, rare, and mostly mild. They include bloating, diarrhea, constipation, and gut lining perforation (extremely rare). Along with the more common side effects, there are also reports of anecdotal side effects, but none that are considered usual risks.
As for long-term risks, if there are any, they are currently unknown due to lack of long-term studies and study follow-up, mainly because use of FMT clinically is still a recent practice.
How effective is FMT for IBS?
It has yet to be determined how effective FMT is to treat IBS. For those with more severe cases of irritable bowel, FMT is a promising new treatment. In early studies, it has been found that 65% of FMT recipients experienced at least temporary relief from their symptoms.
Part of the difficulty with assessing the effectiveness of FMT for IBS is that IBS manifests very differently in each individual. Its symptoms and triggers vary greatly, and can be the result of many combined factors that are difficult to track – which makes assessing the effectiveness off any treatment of the syndrome, including FMT, a complicated task.
It will take the next few years to determine more fully what the effectiveness of treating IBS with FMT is. For now, there are other steps one can take to alleviate their symptoms, like diets, meditation, and medication.
Emerging studies on FMT for treating IBS
FMT studies are a relatively new practice, so many of the results measuring its effectiveness are preliminary. Below are some of the early clinical results on FMT, the microbiome and IBS.
Bacterial differences in IBS sufferers
In a paper out of Italy’s Università degli Studi di Perugia, analysis of data on IBS confirms that the microbiome in those with IBS is altered compared to healthy individuals.
Who Worked on It: Researchers at the Università degli Studi di Perugia, Italy led by Eleonora Distrutti.
Date Published: February 2016
Highlights of Results: An analysis of published data on the gut compositions of those who suffer from IBS indicated differences in the microbial compositions of those with IBS, including having less diversity within their microbiome. Though different studies reached different conclusions as to what exactly the differences were, the evidence as a whole supports a claim that microbiomes between those with IBS and those who are healthy are different.
What’s Next: The authors suggest more and longer-term studies on different microbiota affecting therapies, such as FMT, in order to determine the effectiveness of microbiome manipulation in the treatment of IBS.
The first real FMT IBS study
A study out of Norway’s University Hospital of North Norway Harstad examined the effects of FMT vs a placebo on the symptoms of those with IBS. The results are some of the first solid reports on FMT for the treatment of IBS; they are somewhat promising, but limited.
Who Worked on It: University Hospital of North Norway Harstad, Harstad, Norway team led by Peter Holger Johnsen
Date Published: January 2018
Highlights of Results: This was the first randomised controlled trial looking at the effect of FMT on IBS symptoms. The results of the study showed significant symptoms improvement in the group that received active treatment at 3 months, but the improvement was not maintained at 12 months. In addition, there were also some symptom improvements in 46% of the placebo group, again with no difference at the later 12-month check in.
What’s Next: The researchers concluded that the study supports the microbiome and IBS connection but that more and larger studies would need to be carried out for a more conclusive answer.
Where can I get an FMT?
FMT is not currently widely offered for the treatment of IBS, as studies for it are still in the early stages. Because of this, the use of FMT for IBS is not yet widely condoned. There are some clinics and clinicians that may offer FMT treatment for IBS, but getting FMT from your GP is not currently a likely scenario.
If you are interested in pursuing FMT as a treatment for your IBS, you may want to check out what studies on the subject you might be eligible for. To do that you can check out our recruiting study list here.
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