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Faecal Microbiota Transplantation for Inflammatory Bowel Disease: A Systematic Review and Meta-analysis
Sudarshan Paramsothy1,2,3, Ramesh Paramsothy4, David T Rubin1
1Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.
Background:
Faecal microbiota transplantation [FMT] has been investigated as a potential treatment for inflammatory bowel disease [IBD]. We thus performed a systematic review and meta-analysis assessing the effectiveness and safety of FMT in IBD.
Methods:
A systematic review was conducted until January 2017. Studies were excluded if patients had co-infection or data were pooled across disease subtypes (ulcerative colitis [UC], Crohn's disease [CD], pouchitis). Clinical remission was established as the primary outcome. Pooled effect sizes and 95% confidence intervals were obtained using the random effects model.
Results:
In all, 53 studies were included [41 in UC, 11 in CD, 4 in pouchitis]. Overall, 36% [201/555] of UC, 50.5% [42/83] of CD, and 21.5% [5/23] of pouchitis patients achieved clinical remission. Among cohort studies, the pooled proportion achieving clinical remission was 33% (95% confidence interval [CI] = 23%-43%] for UC and 52% [95% CI = 31%-72%] for CD, both with moderate risk of heterogeneity. For four RCTs in UC, significant benefit in clinical remission (pooled odds ratios [[P-OR] = 2.89, 95% CI = 1.36-6.13, p = 0.006) with moderate heterogeneity [Cochran's Q, p = 0.188; I2 = 37%] was noted. Sub-analyses suggest remission in UC improved with increased number of FMT infusions and lower gastrointestinal tract administration. Most adverse events were transient gastrointestinal complaints. Microbiota analysis was performed in 24 studies, with many identifying increased diversity and a shift in recipient microbiota profile towards the donor post-FMT.
Conclusions:
FMT appears effective in UC remission induction, but long-term durability and safety remain unclear. Additional well-designed controlled studies of FMT in IBD are needed, especially in CD and pouchitis.
Insights
Faecal microbiota transplantation (FMT) shows promise for inducing remission in ulcerative colitis (UC) and Crohn's disease (CD), but long-term safety and efficacy in inflammatory bowel disease (IBD) require further investigation.
Area of Science:
- Gastroenterology
- Microbiology
- Immunology
Background:
- Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn's disease (CD), presents significant clinical challenges.
- Faecal microbiota transplantation (FMT) has emerged as a potential therapeutic strategy for IBD due to its influence on the gut microbiome.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness and safety of FMT in patients with IBD.
- To assess clinical remission rates and adverse events associated with FMT across different IBD subtypes.
Main Methods:
- A systematic review of studies published up to January 2017 was conducted.
- Included studies focused on UC, CD, and pouchitis, excluding those with co-infections or pooled data across disease subtypes.
- Clinical remission was the primary outcome, with pooled effect sizes calculated using a random-effects model.
Main Results:
- Out of 53 studies, 36% of UC patients, 50.5% of CD patients, and 21.5% of pouchitis patients achieved clinical remission.
- Randomized controlled trials (RCTs) in UC demonstrated a significant benefit in clinical remission (pooled odds ratio = 2.89).
- Sub-analyses indicated improved remission in UC with more FMT infusions and lower gastrointestinal administration; adverse events were mostly transient GI complaints. Microbiota analysis revealed increased diversity and a shift towards the donor profile post-FMT.
Conclusions:
- FMT appears effective for inducing remission in UC, though long-term durability and safety require further evaluation.
- Additional well-designed controlled studies are necessary to confirm FMT efficacy, particularly for Crohn's disease and pouchitis.
- FMT modulates the gut microbiota, offering a novel approach to IBD management.
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