E0 ConsensusPreliminaryPEM not requiredReview-NarrativePeer-reviewedReviewed
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Application and development of fecal microbiota transplantation in the treatment of gastrointestinal and metabolic diseases: A review.
Mahmoudi, Hassan, Hossainpour, Hadi · Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2023 · DOI
Quick Summary
This review examines how fecal microbiota transplantation (FMT)—transferring healthy bacteria from a donor's stool to a patient's gut—can treat various diseases. While FMT is very effective for serious C. difficile infections, researchers are exploring whether it might help other conditions including chronic fatigue syndrome, inflammatory bowel disease, and irritable bowel syndrome by restoring a healthy balance of gut bacteria.
Why It Matters
This review highlights the emerging evidence linking gut dysbiosis to chronic fatigue syndrome and underscores the potential role of microbiota-targeted therapies in ME/CFS. For ME/CFS patients with concurrent gastrointestinal dysfunction and dysbiosis, understanding FMT's mechanisms and efficacy across related conditions may inform future treatment strategies and research directions.
Observed Findings
Dysbiosis is associated with multiple GI conditions (CDI, IBD, IBS) and chronic constipation.
FMT is highly effective for recurrent C. difficile infections.
Gut microbiota dysfunction has been implicated in chronic fatigue syndrome, autoimmune diseases, obesity, and neuropsychiatric disorders.
Viral gastroenteritis and SARS-CoV-2 can alter intestinal epithelial cells and appear in stool samples.
Inferred Conclusions
Restoring balanced gut microbiota through FMT is a promising therapeutic strategy for dysbiosis-associated diseases.
The gut microbiota plays a previously underappreciated role in cellular immunity, metabolism, and systemic health.
Clinical adoption of FMT for non-CDI conditions requires rigorous controlled trials and deeper mechanistic understanding.
Viral infections may alter the microbiota-host relationship in ways relevant to chronic disease.
Remaining Questions
Does FMT effectively treat ME/CFS, and if so, what mechanisms drive any clinical benefit?
How does dysbiosis contribute to the pathogenesis of ME/CFS versus arising secondarily from the disease?
What This Study Does Not Prove
This review does not establish that FMT is clinically effective for ME/CFS or other non-CDI conditions—the authors explicitly state that controlled studies are still needed. It also does not prove causality between dysbiosis and ME/CFS; dysbiosis may be a consequence rather than a cause of the disease. The review's narrative approach means it does not systematically evaluate the strength of evidence across all cited studies.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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