Efficacy of Fecal Microbiota Transplantation for Clostridium difficile Infection in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Abstract

Introduction: Fecal microbiota transplantation (FMT) is a safe and effective therapy for recurrent Clostridium difficile infection (CDI) and is being studied as a treatment for inflammatory bowel disease (IBD). CDI is associated with poor outcomes in patients with IBD including increased risk of surgery and mortality. Data on FMT for CDI in patients with underlying IBD are limited. We performed a systematic review and meta-analysis to describe the efficacy and safety of FMT for CDI in IBD patients and its impact on IBD outcomes. Methods: A systematic search of MEDLINE, Embase and Web of Science was performed up to March 2017, followed by manual search of identified studies. We included case series, case-control or cohort studies, and clinical trials of FMT for CDI in IBD patients with clinical resolution of CDI as the primary outcome. Our primary analysis focused on calculating the pooled cure rate after one or more FMT. Additional analyses included IBD outcomes (flare and surgery) after FMT and improvement in IBD symptoms. Results: A total of 12 studies were included: 9 studies with 307 patients reported resolution rates for CDI after 1 FMT and 3 studies with 41 patients reported rates for >1 FMT. The overall pooled resolution rate for CDI in IBD patients was 89% (95% CI, 84.8%-93.3%) with no significant heterogeneity (I2=41%). The pooled resolution rate after one FMT was 84.6% (95% CI, 77.9%-91.3%; I2= 67%) and pooled resolution rate after >1 FMT was (87.6%; 95% CI, 77.1%-94%; I2=0%). Ten studies reported IBD outcomes after FMT; the pooled rate of IBD worsening and IBD therapy escalation after FMT was 16.6% (95 % CI, 8.3%-24.9%) and the pooled rate of surgery for IBD was 3.3% (95% CI, 1.4%-5.2%). Three studies reported a pooled rate of 37.4% (95% CI, 4.3%-70.4%) for improvement of IBD symptoms after FMT. No serious adverse events attributed to FMT were reported. Conclusion: FMT appears to be a highly effective therapy for CDI in patients with IBD; with single or multiple FMTs. Although safe, some patients experienced worsening of IBD after FMT, with very few patients requiring surgery for underlying IBD. In addition, in some patients, IBD symptoms appear to improve after FMT.