Clinical Study Of Fecal Microbiota Transplantation In Diarrhea Irritable Bowel Syndrome With Different Severity

BackgroundThe prevalence of irritable bowel syndrome is increasing by years.Diarrheapredominant IBS is the main type in China.The alteration of intestinal microbiota is highly related to irritable bowel syndrome,and intervention in the treatment of intestinal microbiota has significant value.Researches on fecal microbiota transplantation for IBS-D are increasing,but there are differences in the treatment effects.It is presumed divagate that the response of IBS-D with different severity to fecal microbiota transplantation may be different.IntentionTo analyze the put of symptoms of diarrhea-predominant irritable bowel syndrome patients with variant severity by fecal microbiota transplantation under colonoscopy tube(TET tube).MethodsThere were 68 participants with diarrhea-predominant irritable bowel syndrome from the center of digestive disease of Guangzhou First People's Hospital from June 2017 to June 2019.Approximately patients underwent colonoscopy tube for fecal microbiota transplantation,and the same donor was used.According to IBS-SSS,the severity of IBS-D patients was stratified,and the changes of symptom severity score scale(IBS-SSS),Bristol fecal character scale(BSFS),quality of life(IBS-QOL),anxiety and depression(HAMA/HAMD)in before and after fecal microbiota transplantation were analyzed.16 S rDNA sequencing was used to analyze the changes of fecal microbiota in donor and patients before and 1 month after FMT.The main observational index was the Severity Symptom Score scale(IBS-SSS)at 1 month,3 months,and 6 months after FMT.Response was defined as a decrease in IBS-SSS score of ?50 points,IBS-SSS <75 was classified as remission.The secondary observational indicators were changes in the Bristol Fecal Trait Scale(BSFS),Quality of Life Score(IBS-QOL),and Anxiety and Depression Score(HAMA/HAMD),Changes in the microbiota of patients before and after FMT.Outcomes(1)One month after fecal microbiota transplantation,the overall responsivity of IBS-D patients was 61.76%,and the remission rate was 10.29%.Amidst them,the responsivity of IBS-D patients in the mild,moderate and severe groups were 45.45%,63.64%,and 66.67%,and the rates of remission were 36.36%,6.06%,and 4.17%,respectively.Three months after fecal microbiota transplantation,the overall responsivity of IBS-D patients was 58.82%,and the response rate was 8.82%.Among them,the response rates of IBS-D patients in the mild,moderate and severe groups were 54.55%,54.55%,and 66.67%,and the remission rates were 27.27%,6.06%,and 4.17%,respectively.Six months after fecal microbiota transplantation,the overall responsivity of IBS-D patients was 52.94%,and the response rate was 5.88%.Among them,the responsivity of IBS-D patients in the mild,moderate and severe groups were 27.27%,51.52%,and 66.67%,and the remission rates were 18.18%,3.03%,and 4.17%,respectively.(2)After 1 month,3 months,and 6 months of fecal microbiota transplantation,the IBS-SSS,BSFS,IBS-QOL,HAMA,and HAMD of the IBS-D patients were statistically significant compared with before treatment.(3)IBS-SSS in patients with mild patients decreased significantly only 1 month after fecal microbiota transplantation,and the improvement was not sustained to 3 months.(4)After fecal microbiota transplantation,the stool characteristics of patients with mild IBS-D did not improve significantly,and the number of defecations did not decrease.Compared close by before FMT,the changes in fecal traits and frequency in patients of moderate-to-severe IBS-D remained obviously differences at 3 months after fecal microbiota transplantation.Patients with moderate IBS-D could maintain more than 6 months.(5)There was no significant headway in quality of life in patients of mild IBS-D after fecal microbiota transplantation.Compared with pre-FMT,the improvement of quality of life(IBS-QOL)in patients with moderate to severe IBS-D at 1 month and 3 months after FMT was statistically significant.The advance in the quality of life of moderate IBS-D patients had persisted for more than 6 months.(6)Patients with moderate to severe IBS-D showed marked improvement in anxiety and depression at 1 and 3 months after FMT.The improvement of moderate IBS-D patients after FMT could be maintained for more than 6 months.But patients with mild IBS-D showed a tendency to kickback in anxiety and depression at 6 months after FMT.(7)The Shannon and Simpson diversity index of fecal microbiota in IBS-D patients had an increasing trend after FMT.At the phylum level,the relative abundances of Verrucomincrobia and Euryarchaeota were higher,and the abundance of Firmicutes was lower.At the genus level,the relative abundances of Methanobrevibacter and Akkermansia were higher.ConclusionsFecal microbiota transplantation has a positive effect on improving the clinical symptoms of IBS-D patients.There are differences in the duration of treatment effect in patients with different degrees after FMT.Patients in the mild group are more likely to achieve remission,but the duration of improvement has not exceeded 3 months,whereas,the maintenance response lasted more than 6 months in moderate to severe patients.Fecal microbiota transplantation can improve fecal characteristics,quality of life,and psychological of patients with moderate to severe diarrhea-predominant irritable bowel syndrome,and reduce the number of stool.The psychological influence of mild patients after fecal microbiota transplantation is unknown.Diversity of intestinal microbiota in patients after FMT is increasing.The predominant bacteria of patients and donors are different before and after FMT.It is speculated that the foreign microbiota of the donor interferes with the existing niche allocation of the patient's intestinal microbiota,which is conducive to the re-colonization of the dominant bacteria of the patient and is beneficial to the improvement of clinical symptoms.