What is Irritable Bowel Syndrome (IBS)?
Irritable bowel syndrome is condition which affects the digestive system, mostly the large intestine, and sometimes also the small intestine. It is also known as irritable colon, mucous colitis, spastic colon or spastic colitis, and nervous stomach. In some locations, it affects up to 1 in 5 of the population. In Hong Kong, it is estimated that 10 percent of the population is affected by IBS.1 It is a chronic condition with fluctuating symptoms including:
In the large intestine, IBS may correlate with dysbiosis of the gut causing hypersensitivity, poor peristalsis (migrating motor complex) causing constipation, or intestinal permeability (leaky gut) causing chronic system inflammation or fatigue. In the small intestine, IBS may correlate with small intestine bacterial overgrowth (SIBO) or small intestine fungal overgrowth (SIFO), often causing severe bloating and abnormal stool types.
How is a diagnosis made?
There is no specific test to diagnose IBS. If these symptoms occur, further investigations are usually required. Once other potential GI-conditions are eliminated, such as ulcerative colitis or Crohn’s disease, then your doctor may classify your condition as IBS, giving you the IBS diagnosis. To make a diagnosis of IBS, your doctor will take a full clinical history and examine you, as well as review your previous tests.
Internationally, the key criteria for diagnosis of IBS are:
- Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, AND associated with two or more of the following criteria:
- Related to defecation
- Associated with a change in frequency of stool
- Associated with a change in form (appearance) of stool
Criteria should be fulfilled for the last 3 months. (With symptom onset at least 6 months before diagnosis.)
If these criteria not met, but you are still experiencing some of the above symptoms, you may have a condition known as Functional GI Disorder (FGID). To learn more about FGID, please click here (coming soon).
Why consider Human Microbiota Transplant (HMT) for relief of symptoms related to IBS?
Irritable Bowel Syndrome is a complex GI condition with multiple factors, including hypersensitivity, altered brain-gut interaction, inflammation, and imbalance of the gut microbiota (dysbiosis). Because the gut microbiota are associated with symptoms in some IBS patients, HMT has been studied in the treatment of IBS. More than 1,500 IBS patients have been treated with using HMT, with a variety of results ranging from 36% resolution to 64% resolution after HMT. In the most recent clinical trial on IBS, more than 60% of IBS patients showed an improvement of their symptoms after fecal microbiota transplantation.3
What does the Hong Kong HMT programme involved?
Our centre works closely with renowned gastroenterologists in the region. Our HMT treatment programme is based on protocols from our GI specialist advisors, while taking into account the specific needs of the individual. Our programme is designed to help you get relief and long-term benefit from the symptoms of your condition by restoring the balance of microbiota in your gut.
- Patients will undergo HMT implants on five consecutive days, or on two sets of five consecutive days (10 days total) over a period of 2-3 weeks.
- HMT implants may be delivered via enema, capsules oral formulation, or colonoscopy (additional fees required)
- Prior to undergoing HMT therapy, individuals will undergo a bowel preparation consisting of either standard bowel prep or colonic water lavage.
The goal of Human Microbiota Transplant (HMT) is to help rebalance the gut microbiota, which may alleviate some of the symptoms of a GI-related condition. Irritable Bowel Syndrome is a medical condition, which should be treated underneath the supervision of a medical doctor. Any adjustment to medication or prescriptions must be discussed with your supervising doctor. It is essential, therefore, for clients to obtain a referral letter before symptom-specific treatment can begin.
Article Abstract 1:
Faecal microbiota transplantation versus placebo for moderate-to-severe irritable bowel syndrome: a double-blind, randomised, placebo-controlled, parallel-group, single-centre trial
Peter Holger Johnsen, Frank Hilpüsch, Jorunn Pauline Cavanagh, Ingrid Sande Leikanger, Caroline Kolstad, Per Christian Valle, Rasmus Goll
Lancet Gastroenterol Hepatol 2017
Between Jan 1, and Oct 30, 2015, we recruited 90 participants and randomly assigned them to active treatment (n=60) or placebo (n=30). Three participants did not undergo FMT and four were excluded after diagnosis of microscopic colitis, leaving 83 for final modified intention-to-treat analysis (55 in the active treatment group and 28 in the placebo group).
Responders: 36 (65%) of 55 participants receiving active treatment versus 12 (43%) of 28 receiving the placebo showed response at 3 months (p=0·049).
FMT induced significant symptom relief in patients with IBS. However, larger multicentre studies are needed to confirm the results.
Article Abstract 2:
Efficacy analysis of fecal microbiota transplantation in the treatment of 406 cases with gastrointestinal disorders
To evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for gastrointestinal disorders.
Retrospective analysis of the clinical data of 406 patients who underwent FMT from May 2014 to April 2016 in the Intestinal Microenvironment Treatment Centre of Nanjing General Hospital was performed, including patients with constipation(276 cases), recurrent Clostridium Difficile infection (RCDI, 61 cases), ulcerative colitis(44 cases), irritable bowel syndrome (15 cases) and Crohn’s disease(10 cases). Donors were completely unrelated, 18- to 50-year-old non-pregnant healthy adult, with healthy lifestyle and habits, without taking antibiotics, probiotics and other probiotics history within 3 months. There were three routes of FMT administration: patients received 6 days of frozen FMT by nasointestinal tube placed in the proximal jejunum under gastroscope (319 cases); patients received capsules FMT per day for 6 consecutive days (46 cases) or once 600 ml of treated fecal liquid infusion into colon and terminal ileum by colonoscopy(41 cases).
Clinical cure rate and improvement rate of different diseases receiving FMT were respectively as follows: RCDI was 85.2% (52/61) and 95.1%(58/61); constipation was 40.2%(111/276) and 67.4%(186/276); ulcerative colitis was 34.1%(15/44) and 68.2% (30/44); irritable bowel syndrome was 46.7% (7/15) and 73.3% (11/15) and Crohn disease was 30.0%(3/10) and 60.0%(6/10). RCDI had the best efficacy among these diseases(P<0.01). There was no significant difference between the three routes of FMT administration(P=0.829). The clinical cure rate and improvement rate of different routes were 43.3%(138/319) and 58.6% (187/319) respectively in nasogastric transplantation group, 41.5%(17/41) and 61.0%(25/41) in colonoscopy group, 37.0%(17/46) and 63.0% (29/46) in the capsule transplantation group. There was no serious adverse event during the follow-up. The most common side effects were respiratory discomfort (27.3%, 87/319) and increased venting (51.7%, 165/319) in nasogastric transplantation group. Diarrhea was the most common complication in colonoscopy group (36.6%, 15/41). The main symptoms were increased venting (50.0%, 23/46) and nausea(34.8%, 16/46) in oral capsule group. Side effect symptoms disappeared after the withdraw of nasogastric tube, or at the end of treatment, or during hospitalization for 1-3 days.
FMT is effective for many gastrointestinal disorders. No significant adverse event is found, while the associated mechanism should be further explored.
Article Abstract 3:
Olga C. Aroniadis; Lawrence J. Brandt
Curr Opin Gastroenterol. 2013;29(1):79-84.
“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. Probiotics can restore the intestinal microbiota in patients with IBS[49,51] and result in improvement of postinfectious IBS in animal models; 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. 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. Normal defecation, without laxative use, persisted in 18 of 30 patients (60%) contacted 9–19 months later.
Article Abstract 4:
Healio, Gastroenterology Report
May 8, 2017
“It seems that FMT has a beneficial effect on symptom scores and on quality of life in IBS patients. However, this effect is also observed in the placebo group, although to a lesser extent, but this indicates that placebo controlled studies are definitely necessary in IBS patients,” Savanne Holster, PhD, of the Nutrition-Gut-Brain Interactions Research Center at Örebro University in Sweden, said during her presentation.
Holster and colleagues randomly assigned 16 patients with IBS to receive FMT via colonoscopy using either donor material or their own fecal material as placebo. The researchers assessed symptom scores and quality of life before and after the procedure.
IBS Symptom Severity Scores in patients who received donor FMT dropped significantly at 4 and 8 weeks after treatment compared with baseline (P < .01 for both), while there were no significant changes observed in the placebo group. There were also no significant differences observed in IBS-SSS between the treatment and placebo groups.