Abstract
The response of patients with inflammatory bowel disease (IBD) to fecal microbial transplantation (FMT) has been inconsistent possibly due to variable engraftment of donor microbiota. This failure to engraft has resulted in the use of several different strategies to attempt optimization of the recipient microbiota following FMT. The purpose of our study was to evaluate the effects of two distinct microbial strategies—antibiotic pre-treatment and repeated FMT dosing—on IBD outcomes. A systematic literature review was designed and implemented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A medical librarian conducted comprehensive searches in MEDLINE, Embase, Scopus, Web of Science Core Collection, and Cochrane Library on 25 November 2019 and updated on 29 January 2021. Primary outcomes of interest included comparing relapse and remission rates in patients with IBD for a single FMT dose, repeated FMT dosages, and antibiotic pre-treatment groups. Twenty-eight articles (six randomized trials, 20 cohort trials, two case series) containing 976 patients were identified. Meta-analysis revealed that both repeated FMT and antibiotic pre-treatment strategies demonstrated improvements in pooled response and remission rates. These clinical improvements were associated with increases in fecal microbiota richness and α-diversity, as well as the enrichment of several short-chain fatty acid (SCFA)-producing anaerobes including Bifidobacterium, Roseburia, Lachnospiraceae, Prevotella, Ruminococcus, and Clostridium related species.
Highlights
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract categorized by Crohn’s disease (CD), ulcerative colitis (UC), and indeterminate colitis [1,2]
Our meta-analysis revealed that repeated fecal microbial transplantation (FMT) and antibiotic pre-treatment were associated with improvements in both pooled IBD response and pooled remission rates
Our study addresses a number of these gaps by evaluating both high-quality randomized controlled trials (RCTs) and cohort studies, which allowed us to characterize the impact of FMT frequency and antibiotic pre-treatment on IBD outcomes
Summary
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract categorized by Crohn’s disease (CD), ulcerative colitis (UC), and indeterminate colitis [1,2]. Gut microbial communities of patients with IBD are characterized by reduced microbial diversity, an increased abundance of aerobic pro-inflammatory bacteria, and a reduction in anaerobic bacteria that generate beneficial anti-inflammatory metabolites, such as short-chain fatty acids (SCFA). These findings have fostered growing interest in adopting microbiota-targeted strategies into the forefront of modern IBD therapeutics [18,19,20] in order to reduce the need for long-term immunosuppressants and their associated adverse complications
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