Washed microbiota transplantation improves symptoms and intestinal barrier function in patients with functional bowel disorders: a propensity-score matching analysis

Abstract

Abstract Background Alterations in the intestinal microbiota may have a role in functional bowel disorders (FBDs) pathogenesis. Probiotics are widely used to improve intestinal dysbacteriosis in patients suffering from FBDs. Compared with probiotics, washed microbiota transplantation (WMT) could be a promising treatment for FBDs. We conducted a retrospective evaluation of both treatments using a propensity-score matching analysis (PSMA). Methods A total of 103 patients with FBDs (irritable bowel syndrome (IBS), functional constipation (FC), functional diarrhea (FDr), functional abdominal bloating (FAB)) were divided into a WMT group or probiotics group (taking probiotics capsules). The following information was matched for PSMA: age, sex, disease course, body mass index, anxiety, insomnia, tobacco smoking, alcohol consumption, as well as levels of D-lactate, diamine oxidase (DAO), and lipopolysaccharide (LPS). IBF and symptoms were evaluated at the first and second hospitalizations. Prognostic factors were assessed by Cox proportional hazards regression analysis. Results PSMA resulted in 34 matched pairs (11 IBS, 12 FC, 7 FDr, and 4 FAB in the probiotics group and 14 IBS, 13 FC, 5 FDr, and 2 FAB in the WMT group). WMT was better for improving symptoms in FBD patients than probiotics (P = 0.002). Significantly fewer patients with intestinal barrier damage were in the WMT group than the probiotics group (38.2% vs. 67.6%, P = 0.041). D-lactate levels were reduced significantly after WMT (P = 0.031) and were selected as the prognostic factor for FBDs (HR = 0.248, 95%CI 0.093–0.666, P = 0.006) by univariate Cox regression analysis. Conclusion WMT could improve symptoms and IBF in patients with FBDs. Increased D-lactate levels may predict a strong efficacy of WMT in these patients.