Table 1. Systematic review on the effectiveness of FMT in IBS patients Improvement Improvement FMT vs Pla- in IBS-QoL Study type Author Patients Route Dose Frequency in IBS symp- cebo score from toms baseline 10/24 (48%) vs 15/24 (63%) (p= 0.32) IBS- 12±5 vs Aroniadis et 25 cap/d con- SSS score 14±5 (p= RCT al (2018) 48 (IBS-D) 24 vs 24 Capsule taining 50gm 3 days reduction 0.62) at 3 USA feces >50 points at months 3 months from base- line 8/22 (36%) vs 19/24 (79%) (p= 0.008) IBS- 7±10 vs Halkjaer et al 25 cap/d con- 51 (all types SSS score 16±10 (p= RCT (2018) 25 vs 26 Capsule taining 50gm 12 days of IBS) reduction 0.003) at 3 DENMARK feces >50 points at months 3 months from base- line 20/41(49%) vs 6/ 21(29%) (P= 16% in FMT 0.004) Self- Holvent et al group, no 64 IBS with reported RCT (2018) 42 vs 22 Naso-jejunal N/A Once data for pla- bloating improve- BELGIUM cebo at 3 ments in months IBS/bloating symptoms at 3 months 36/55 (65%) vs 12/28 (43%) (P= 0.049) IBS- Johnsen et al 50-80 gm of 83 (IBS-M, SSS score RCT (2018) 55 vs 28 Colonoscopy feces in 200 Once N/A IBS-D) reduction NORWAY ml saline >75 points at 3 months from base- line in IBS-SSS 10.0 ± 6.3 in score FMT group Holster et al 63.3±43 at 2 16 (all types (at 2 RCT (2018) 8 vs 8 Colonoscopy N/A Once months in of IBS) months), no SWEDEN FMT group, data in pla- no data in cebo placebo Bruno et al 2/3 (66%) at 3 (IBS-D, at 0 and 3 RCT (2018) 3 vs 0 Enema N/A 6weeks in N/A IBS-U) weeks ITALY FMT group 4/10 (40%) (IBS-SSS 10 (antibi- score reduc- 15% in FMT Open label Beurden et al otic as well Naso- Duo- 198 ml N/A Once tion >30% at group (at 2 study (2017) as post-infec- denal donor feces 2 months months) tious IBS) from base- line 13% in FMT Open label Holvent et al 12 IBS-D, 300 ml 9/12(75%) at N/A Colonoscopy Once group (at 3 study (2016) bloating donor feces 3 months months) 100 gm feces Open label Mizuno et al 10 All types 6/10 (60%) N/A Colonoscopy in 200 ml Once N/A study (2017) of IBS at 1 month NS Open label Cruz et al 9 (IBS-C and Colonoscopy 6/9 (66%) at N/A N/A Once N/A study (2015) IBS-D) and enema 3 months Retrospective Pinn et al 13 All type Jejunal or 50-100 ml 9/13 (70%) N/A Once N/A study (2014) of IBS Duodenal donor feces at 11 months Retrospective Li et al 11/15 15 N/A N/A N/A N/A N/A study (2017) (73.3%) Andrews et 1/1 (100%) Case report 1 IBS-C N/A Enema N/A 2 days N/A al (1992) at 18 months 3/3 (100%) Borody et al Case series 3 IBS-C N/A Enema N/A 5 days at 8-28 N/A (2004) months 8/10 (80%) Hong et al Case series 10 N/A N/A N/A N/A patients at 1 N/A (2016) month Syzneko et al 12 all type 9/12 (75%) Case series N/A Colonoscopy N/A Once N/A (2016) of IBS at 1 month Reduction in IBS-SSS score (p= Mazzawi et 0.0002) and Case series 9 IBS-D N/A N/A N/A N/A N/A al (2016) Bristol stool scale (p= 0.02) at 3 weeks Reduction in Vivekanan- daily BM Retrospective 15 IBS-D, Colonoscopy drajah et al N/A N/A N/A post-treat- N/A study IBS-C or enema (2017) ment in IBS- D (p<0.05) Tu1878 FECAL MICROBIOTA TRANSPLANTATION (FMT) IN IRRITABLE BOWEL SYNDROME (IBS): A SYSTEMATIC REVIEW AND META-ANALYSIS Kanchana Myneedu, Max J. Schmulson, Mohammad Bashashati Background: IBS is a disorder of gut-brain interaction with multifactorial etiology. Dysbiosis is considered one of the underlying mechanisms, therefore modulation of gut microbiota with agents such as probiotics and prebiotics has been suggested as a treatment (Aliment Pharmacol Ther. 2018; 48:1044-1060). More recently, FMT has been proposed as a potential therapeutic option (Curr Opin Pharmacol. 2018; 43:72-80). The aim of current meta-analysis is to understand whether FMT is an effective treatment in IBS. Methods: PubMed, Embase, Google Scholar, and abstract books of DDW 2010-2018 and UEGW 2010-2018 were searched for interventional studies on FMT in IBS. Both randomized placebo-controlled (RCTs) and single-arm trials (SATs) were included in this meta-analysis. Response to treat- ment was defined as number of patients with symptom improvement divided by the total number of studied patients and reported as Ratio (95% Confidence Interval) and Relative Ratio (RR; 95% CI) for SATs and RCTs, respectively. Changes in symptom severity scores in FMT vs. placebo groups were compared using the standard mean difference (SMD) S-1157 AGA Abstracts method. Heterogeneity was measured based on I 2 value. Random and fixed-effect models were used when I 2 >50% and I 2 ≤50%, respectively. Results: Eleven SATs and 5 RCTs on FMT in IBS were retrieved. Eight SATs (n=90 patients in total) and 4 RCTs (overall n=143 in FMT and n=97 in placebo) reported number of cases with improvement of IBS symptoms and were included in this meta-analysis. The duration of the follow-up in the SATs was 3 weeks to 18 months, while in the RCTs, was up to 24 months. All included RCTs had an assessment at 12 weeks; therefore, the 12-week outcome was selected for the analysis. In the SATs, 59.5% (95%CI: 49.1, 69.3) of IBS patients showed significant improvement of IBS symptoms (Figure 1). Meta-analysis of the RCTs showed no difference between FMT and placebo in IBS symptom improvement: RR: 0.93 (95%CI: 0.50, 1.75) (Figure 2). Changes from baseline in the IBS-Severity Scoring System (IBS-SSS), were not different in the FMT than in the placebo group [standard mean difference (SMD): -12.9 (95%CI: -137.9, 112.2)]. Further, changes from baseline in the IBS-Quality of Life (IBS-QOL) were not different between FMT vs placebo (SMD: 0.02 (95%CI: -0.30, 0.33)). Conclusions: Based on the current meta-analysis, FMT is not superior to placebo in the treatment of IBS and there is heterogeneity in the trials of FMT in IBS. Variations in the administration methods of FMT, donor factors, duration of follow-up and patient factors such as IBS subtypes or the presence of other comorbidities may contribute to the heterogeneous results of the currently available trials. Response to FMT in the SATs could be related to a lack of placebo comparators effect as data from the RCTs do not show any difference between FMT and placebo. Figure 1) Meta-analysis of SATs showing 59.5% [95%CI: 49.1, 69.3] of patients had improve- ment of IBS symptoms with FMT. Figure 2) meta-analysis of RCTs indicating no difference between FMT and placebo in improving IBS symptoms. Tu1879 RAPID AND DURABLE ENGRAFTMENT OF DONOR FUNGI AND BACTERIA AFTER SUCCESSFUL FECAL MICROBIOTA TRANSPLANTATION IN ACUTE GRAFT-VERSUS-HOST DISEASE: INTENSIVE SERIAL METAGENOMICS STUDY Fen Zhang, Yun Kit Yeoh, Frankie Cheng, Tao Zuo, Whitney Tang, Kitty Cheung, Keli Yang, Qin Liu, Chun Pan Cheung, Chung Mo Chow, Francis K. Chan, Chi-Kong Li, Paul K. Chan, Siew C. Ng Background Recent case series showed that FMT is a promising treatment for acute refractory Graft-versus-host disease (aGVHD). The mechanisms underlying FMT success however is unclear. We report for the first time bacterial and fungal alterations in association with disease resolution in an aGVHD case after multiple fecal microbiota transplantations (FMT). Method A 14-year-old boy with severe life-threatening grade-4 gut aGVHD, refractory to corticosteroids and biologic therapies, were treated with a total of four FMTs. FMTs were conducted by duodenojejunal infusion from two different donors. Fecal samples were col- lected at baseline and every 5 days (22 time points) up to 120 days after FMT. Combined DNA extraction of fecal bacteria and fungi was performed, followed by ultra-deep metagenomics sequencing and profiling of bacteriome and fungome. Clinical phenotype and outcome were assessed and correlated with microbial profiles. Result Compared with donor fecal fungome, patient with aGVHD showed decreased fungal diversity and a 60-fold increase in the fungus Fusarium oxysporum and a 10-fold increase in the fungus Botrytis cinereal. Fungal composi- tion of the patient was restored and resembled that of the donor soon after receiving the first FMT, and these changes remained durable up to day 120. The three most abundant fungal species in donor, Colletotrichum higginsianum, Cercospora beticola and Thielavia AGA Abstracts