FMT for Post-infectious IBS

Study Overview
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Brief Summary
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Considering that PI-IBS is brought on by infection and gut microbiota may be associated with the onset of symptoms, the modification of altered gut microbiota with nonabsorbable antibiotics such as rifaximin-α or probiotics is often employed as first-stage treatment. Research in recent years has also shown the potential benefits of fecal microbiota transplantation (FMT) for IBS, which is the replacement of a sick recipient's gut microbiota with fecal material from a healthy donor. Even though the only officially approved indication for FMT at this time is recurrent Clostridium difficile infection, the effectiveness of FMT is nevertheless being studied for the treatment of other gastrointestinal and non-gastrointestinal pathologies including IBS. To date, several controlled and uncontrolled studies have been conducted to study the effectiveness of FMT for IBS, and most of them have demonstrated positive results. The investigators have not come across studies devoted to the study of the effectiveness of FMT in patients with PI-IBS in the available literature. So, the aim of the current study was to conduct single-centre, randomized clinical trial to assess the safety, clinical and microbiological efficacy of FMT in patients with PI-IBS.

Official Title
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Fecal Microbiota Transplantation in Patients With Post-infection Irritable Bowel Syndrome: a Randomized, Clinical Trial

Conditions
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Irritable Bowel Syndrome

Intervention / Treatment
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* Biological: Fecal transplantation
* Drug: OTILONII BROMIDUM
* Dietary Supplement: multi-strain probiotic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria age 18-65 years PI-IBS diagnosis in accordance with the Rome IV criteria moderate-severe disease activity (as determined by an IBS-Symptom Severity Score ≥175) normal appearing colon on colonoscopy with biopsy that did not reveal pathology signed inform consent. Exclusion Criteria: systemic disease, immunodeficiency, or previous treatment with immunomodulators; pregnant or breastfeeding; previous surgery on the abdominal cavity, with the exception of appendectomy, cholecystectomy, caesarean section and hysterectomy; severe current disease (hepatic, renal, respiratory, or cardiovascular); probiotic or antibiotic use within 8 weeks prior to study initiation; any condition or circumstance that would, in the opinion of the investigator, prevent completion of the study or interfere with analysis of study results.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Fecal transplantation group<br>Fecal transplantation of frozen prepared feces from healthy donor. Application by colonoscope in proximal half of colon. | Biological: Fecal transplantation<br>* Preparation of flesh feces by blending in 0.9 % saline and crude filtering. The solution is applied in proximal colon of IBS patient by colonoscopy after standard bowel preparation.<br>* Other names: Fecal microbial transplantation;|
| Active Comparator: Standard-care group<br>FODMAP diet, Otilonium Bromide, oral, (40mg, 1 tablet TID) and a multi-strain probiotic, oral, (1 capsule BID) | Drug: OTILONII BROMIDUM<br>* OTILONII BROMIDUM , oral, 40 mg TID, 1 months of treatment<br>* Other names: Spasmomen®;Dietary Supplement: multi-strain probiotic<br>* multi-strain probiotic, oral, 1 capsule BID for 1 month<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Irritable bowel syndrome severity scoring system (IBS-SSS) | This questionnaire contains five questions, each with a maximum score of 100 using a visual analog scale. Total scores between 75 and 175 were considered indicative of mild IBS severity, 175-300 were moderate, and >300 were severe. | at 0, 2, 4 and 12 weeks | 
| assesment of response rate | response rate was assessed as decrease of ≥ 50 points on the IBS-SSS | at 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in BS Quality of Life Scale (IBS-QoL) | This questionnaire contains 34 items concerning the physical and psychological functioning of IBS patients in 8 domains: dysphoria, activity interference, body image, health concerns, food avoidance, social reactions, sexual function and impact on relationships. | at 0, 2, 4 and 12 weeks | 
| Change in Fatigue Assessment Scale (FAS) | The questionnaire comprises 10 questions with 5-point-scale answers varying from never to always. Five of these questions measured physical fatigue and the other five measured mental fatigue. | at 0, 2, 4 and 12 weeks | 
| Bacteriology measured in the stool flora by specialized non-culture techniques | The percentage of patients in each group were evaluated and characterized by a decrease below the normal content of symbiotic bacteria Bifidobacterium (less than 107 CFU / g), lactobacilli (less than 107 CFU / d), E.coli with normal properties (less than 106 CFU / d) and increase in content E.coli with altered properties (more than 106 CFU / g), pathogenic enterobacteria (not normally detected) and fungi of the genus Candida (more than 104 CFU / d) | at 0 and 1 months | 
| Microbiome profile change | Characterization of fecal microbiome by metagenomic analysis before and after intervention Characterization of fecal microbiome by metagenomic analysis before and after intervention | at 0 and 1 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Irritable Bowel Syndrome, fecal microbiota transplantation, postinfectious irritable bowel syndrome