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Abstract
Aim Increasing evidence supports the role of the gut microbiota in the etiology of ulcerative colitis (UC). Fecal microbiota transplantation (FMT) is a highly effective treatment against recurrent Clostridium difficile infection; however, its efficacy in UC is still controversial. A systematic review and meta-analysis was conducted to evaluate the efficacy and safety of FMT for treatment of active UC. Methods We searched Cochrane, Medline, Web of Science, and Embase from inception to February 2020. Randomized controlled trials (RCTs) recruiting adults with active UC, which compared FMT with controls, were eligible. The primary outcome was combined clinical remission with endoscopic remission/response. Secondary outcomes included clinical remission, endoscopic remission, and serious adverse events. Relative risk (RR) with 95% confidence interval (CI) is reported. Results Five RCTs with 292 participants were eligible for inclusion. When data were pooled for all patients, FMT was associated with a higher combined clinical remission with endoscopic remission/response; the RR of combined outcome not achieving after FMT vs. control was 0.79 (95% CI 0.70-0.88). FMT delivered via lower gastrointestinal route was superior to upper gastrointestinal route with regard to combined clinical remission with endoscopic remission/response (RR = 0.79, 95% CI 0.70-0.89). FMT with pooled donor stool (RR = 0.69, 95% CI 0.56-0.85) and higher frequency of administration (RR = 0.76, 95% CI 0.62-0.93) may be more effective with regard to clinical remission. There was no statistically significant difference in serious adverse events with FMT compared with controls (RR = 0.98, 95% CI 0.93-1.03). Conclusion FMT shows a promising perspective with comparable safety and favorable clinical efficacy for the treatment of active UC in the short term. However, further larger, more rigorously conducted RCTs of FMT in UC are still needed in order to resolve the controversial questions.
Highlights
Ulcerative colitis (UC) is characterized by chronic inflammation of the colon, as well as the periodicity of disease progression and remission [1]
Our meta-analysis demonstrated that Fecal microbiota transplantation (FMT) is effective to mild to moderate active UC in the short term
They observed 17.4% (43/247) FMT-related adverse events (AEs) including one serious adverse events (SAEs). They found that both the method of preparation of microbiota from stool using the automatic system and the delivery method of colonic transendoscopic enteral tubing (TET) were associated with a lower rate of FMT-related AEs. All of these results demonstrated that FMT-related AEs were mild or moderate and self-limiting
Summary
Ulcerative colitis (UC) is characterized by chronic inflammation of the colon, as well as the periodicity of disease progression and remission [1]. The imbalance of the gut microbiota has been suggested to markedly impact UC progression [3]. Fecal microbiota transplantation (FMT) refers to the therapeutic procedure of transplanting fecal bacteria from healthy persons into patients [4]. It is highly efficacious for the treatment of recurrent Clostridium difficile infection (CDI), with mean cure rates in the range of 87%-90% [5, 6]. Beyond CDI, FMT has been investigated as a treatment option in a variety of diseases, such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), hepatic encephalopathy, autism, metabolic syndrome, and so on [7]. The efficacy and safety of FMT for treatment of UC is still controversial. There were meta-analyses examining this issue [9, 10], one of them by Narula et al [9] did not identify the study by Crothers et al
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