Fecal Microbiota Transplantation for Chronic Pouchitis: A Systematic Review and Meta-Analysis

Area of Science:

• Gastroenterology
• Microbiome Research
• Surgical Complications

Background:

• Pouchitis is a frequent complication following ileal-pouch anal anastomosis in patients with ulcerative colitis.
• Existing evidence on the safety and efficacy of fecal microbiota transplantation (FMT) for chronic pouchitis is limited.
• High-level evidence is needed to guide clinical recommendations for FMT in this patient population.

Purpose of the Study:

• To systematically evaluate the outcomes and complications of fecal microbiota transplantation (FMT) for chronic pouchitis.
• To synthesize data from existing studies to provide a pooled analysis of remission, response, relapse, and adverse events.
• To assess the current evidence base for FMT in managing chronic pouchitis.

Main Methods:

• Systematic literature search of English-only original studies from inception to March 31, 2024.
• Inclusion criteria focused on studies investigating chronic pouchitis exclusively.
• Primary outcomes included overall remission, clinical response, remission, relapse rates, and adverse events.

Main Results:

• Seven studies with 94 patients were included in the meta-analysis.
• Pooled overall remission rate was 15%, clinical response rate was 33%, and clinical remission rate was 14%.
• A pooled proportion of 39% of patients experienced mild adverse events; no severe adverse events or deaths were reported.

Conclusions:

• Fecal microbiota transplantation (FMT) demonstrates efficacy in treating chronic pouchitis.
• Despite its effectiveness, FMT is associated with a significant rate of mild adverse events.
• The scarcity of high-level evidence necessitates further research to support broader clinical application of FMT for chronic pouchitis.