Faecal Microbiota Transplantation for Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Sudarshan Paramsothy; Ramesh Paramsothy; David T Rubin; Michael A Kamm; Nadeem O Kaakoush; Hazel M Mitchell; Natalia Castaño-Rodríguez

doi:10.1093/ecco-jcc/jjx063

Faecal Microbiota Transplantation for Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

J Crohns Colitis. 2017 Oct 1;11(10):1180-1199. doi: 10.1093/ecco-jcc/jjx063.

Authors

Sudarshan Paramsothy^{1

2

3}, Ramesh Paramsothy⁴, David T Rubin¹, Michael A Kamm⁵, Nadeem O Kaakoush⁶, Hazel M Mitchell², Natalia Castaño-Rodríguez²

Affiliations

¹ Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.
² School of Biotechnology & Biomolecular Sciences, University of New South Wales, Sydney, NSW, Australia.
³ St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
⁴ Department of Gastroenterology, Liverpool Hospital, Sydney, NSW, Australia.
⁵ Departments of Gastroenterology and Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia.
⁶ School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.

PMID: 28486648
DOI: 10.1093/ecco-jcc/jjx063

Abstract

Background: Faecal microbiota transplantation [FMT] has been investigated as a potential treatment for inflammatory bowel disease [IBD]. We thus performed a systematic review and meta-analysis assessing the effectiveness and safety of FMT in IBD.

Methods: A systematic review was conducted until January 2017. Studies were excluded if patients had co-infection or data were pooled across disease subtypes (ulcerative colitis [UC], Crohn's disease [CD], pouchitis). Clinical remission was established as the primary outcome. Pooled effect sizes and 95% confidence intervals were obtained using the random effects model.

Results: In all, 53 studies were included [41 in UC, 11 in CD, 4 in pouchitis]. Overall, 36% [201/555] of UC, 50.5% [42/83] of CD, and 21.5% [5/23] of pouchitis patients achieved clinical remission. Among cohort studies, the pooled proportion achieving clinical remission was 33% (95% confidence interval [CI] = 23%-43%] for UC and 52% [95% CI = 31%-72%] for CD, both with moderate risk of heterogeneity. For four RCTs in UC, significant benefit in clinical remission (pooled odds ratios [[P-OR] = 2.89, 95% CI = 1.36-6.13, p = 0.006) with moderate heterogeneity [Cochran's Q, p = 0.188; I2 = 37%] was noted. Sub-analyses suggest remission in UC improved with increased number of FMT infusions and lower gastrointestinal tract administration. Most adverse events were transient gastrointestinal complaints. Microbiota analysis was performed in 24 studies, with many identifying increased diversity and a shift in recipient microbiota profile towards the donor post-FMT.

Conclusions: FMT appears effective in UC remission induction, but long-term durability and safety remain unclear. Additional well-designed controlled studies of FMT in IBD are needed, especially in CD and pouchitis.

Keywords: Crohn’s disease; faecal microbiota transplantation; inflammatory bowel disease; meta-analysis; pouchitis; systematic review; ulcerative colitis.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Colitis, Ulcerative / therapy
Crohn Disease / therapy
Fecal Microbiota Transplantation*
Gastrointestinal Microbiome
Humans
Inflammatory Bowel Diseases / therapy*
Treatment Outcome