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Published on: December 8, 2014
Faecal Microbiota Transplantation [FMT] in the Treatment of Chronic Refractory Pouchitis: A Systematic Review and
Shafquat Zaman1, Akinfemi Akingboye2, Ali Yasen Y Mohamedahmed3
1Institute of Cancer and Genomic Science, College of Medical and Dental Science, University of Birmingham, Birmingham, UK.
Background:
The aim of this systematic review and meta-analysis is to assess the efficacy and safety of faecal microbiota transplantation [FMT] in the treatment of chronic pouchitis.
Methods:
A PRISMA-compliant systematic review and meta-analysis was conducted using the following databases and clinical trial registers: Medline, Embase, Scopus, Cochrane Database of Systematic Reviews [CENTRAL], clinical trials.gov, ScienceDirect, and VHL [virtual health library]. The primary outcome was clinical response/remission in patients treated with FMT. Secondary outcomes included safety profile, quality of life, and changes in the gut microbiome.
Results:
Seven observational cohort studies/case series and two randomised, controlled trials with a total of 103 patients were included. The route, preparation, and quantity of FMT administered varied among the included studies. Clinical response rate of 42.6% with a remission rate of 29.8% was estimated in our cohort following FMT therapy. Minor, self-limiting, adverse events were reported, and the treatment was well tolerated with good short- and long-term safety profiles. Successful FMT engraftment in recipients varied and, on average, microbial richness and diversity was lower in patients with pouchitis. In some instances, shifts with specific changes towards abundance of species, suggestive of a 'healthier' pouch microbiota, were observed following treatment with FMT.
Conclusion:
The evidence for FMT in the treatment of chronic pouchitis is sparse, which limits any recommendations being made for its use in clinical practice. Current evidence from low-quality studies suggests a variable clinical response and remission rate, but the treatment is well tolerated, with a good safety profile. This review emphasises the need for rationally designed, well-powered, randomised, placebo-controlled trials to understand the efficacy of FMT for the treatment of pouchitis.
Insights
Faecal microbiota transplantation (FMT) shows a variable clinical response for chronic pouchitis but is well-tolerated. More high-quality trials are needed to confirm its efficacy and safety in treating this condition.
Area of Science:
- Gastroenterology
- Microbiome Research
- Inflammatory Bowel Disease
Background:
- Chronic pouchitis is a debilitating complication following ileal pouch-anal anastomosis.
- Current treatment options for chronic pouchitis have limitations, necessitating exploration of novel therapies.
Conclusions:
- Evidence for FMT in chronic pouchitis is limited due to sparse, low-quality data.
- Suggests variable efficacy but good tolerability and safety.
- Highlights the urgent need for well-powered, randomized, placebo-controlled trials.
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