Primum non nocere: is faecal microbiota transplantation doing harm to patients with IBS?

A recent paper in this journal1 caught my attention: In a well-designed placebo-controlled trial of faecal microbiota transplantation (FMT) in patients with IBS, 12 days of blinded provision of the transplant or placebo in capsules improved symptoms in patients randomised to placebo significantly better than in patients receiving FMT, for IBS symptom severity at 3 and 6 months, and for IBS quality of life at 1, 3 and 6 months of follow-up. Patients receiving FMT showed sustained alterations of their microbiota, obviously unrelated to the symptom burden.

Taking the effect of FMT on the gut microbiota in IBS aside (that has a scientific value by itself), these results not only imply that improvements seen with FMT in IBS in controlled2 and poorly or uncontrolled3 4 studies may be entirely due to placebo effects, on average 40% in IBS.5 It also implies that...

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