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Meta-Analysis
. 2014 Dec;8(12):1569-81.
doi: 10.1016/j.crohns.2014.08.006. Epub 2014 Sep 13.

Fecal microbiota transplantation as therapy for inflammatory bowel disease: a systematic review and meta-analysis

Ruben J Colman  1 , David T Rubin  2
Affiliations
Meta-Analysis

Fecal microbiota transplantation as therapy for inflammatory bowel disease: a systematic review and meta-analysis

Ruben J Colman et al. J Crohns Colitis. 2014 Dec.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Crohns Colitis. 2023 Jan 27;17(1):149. doi: 10.1093/ecco-jcc/jjac104. J Crohns Colitis. 2023. PMID: 35971821 Free PMC article. No abstract available.

Abstract

Background and aims: Fecal microbiota transplantation (FMT) has gained interest as a novel treatment option for inflammatory bowel diseases (IBD). While publications describing FMT as therapy for IBD have more than doubled since 2012, research that investigates FMT treatment efficacy has been scarce. We conducted a systematic review and meta-analysis to evaluate the efficacy of FMT as treatment for patients with IBD.

Methods: A systematic literature search was performed through May 2014. Inclusion criteria required FMT as the primary therapeutic agent. Clinical remission (CR) and/or mucosal healing were defined as primary outcomes. Studies were excluded if they did not report clinical outcomes or included patients with infections.

Results: Eighteen studies (9 cohort studies, 8 case studies and 1 randomized controlled trial) were included. 122 patients were described (79 ulcerative colitis (UC); 39 Crohn's disease (CD); 4 IBD unclassified). Overall, 45% (54/119) of patients achieved CR during follow-up. Among the cohort studies, the pooled proportion of patients that achieved CR was 36.2% (95% CI 17.4%-60.4%), with a moderate risk of heterogeneity (Cochran's Q, P=0.011; I(2)=37%). Subgroup analyses demonstrated a pooled estimate of clinical remission of 22% (95% CI 10.4%-40.8%) for UC (P=0.37; I(2)=0%) and 60.5% (95% CI 28.4%-85.6%) for CD (P=0.05; I(2)=37%). Six studies performed microbiota analysis.

Conclusions: This analysis suggests that FMT is a safe, but variably efficacious treatment for IBD. More randomized controlled trials are needed and should investigate frequency of FMT administration, donor selection and standardization of microbiome analysis.

Keywords: Fecal microbiota transplantation; Inflammatory bowel disease; Meta-analysis; Microbiome; Mucosal healing; Systematic review.

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Figures

Figure 1
Figure 1
Flow-diagram of identified studies.
Figure 2
Figure 2
Forest plot of all cohort studies overall Pooled estimate of clinical remission (CR) of 36.2% (95% CI 17.4%-60.4%).
Figure 3
Figure 3
Individual forest plots of subgroups: Figure 3a Forest plot of UC only. Pooled estimate of CR 22% (95% CI 10.4%-40.8%). Figure 3b UC without pouchitis. Pooled estimate of CR 24.1% (95% CI 11.1%-44.9%). Figure 3c CD only Pooled estimate of CR 60.5% (95% CI 28.4%-85.6%).; Figure 3d Young population (age 7-20yrs) studies only. Pooled estimate of CR 64.1% (95% CI 10.6%-96.4%.
Figure 4
Figure 4
Funnel plot of main meta-analysis (all cohort studies).
Figure 5a
Figure 5a
Funnel plot of UC meta-analysis.
Figure 5b
Figure 5b
Funnel plot of UC meta-analysis, but pouchitis excluded.
Figure 5c
Figure 5c
Funnel plot of CD meta-analysis, but pouchitis excluded.
Figure 5d
Figure 5d
Funnel plot of meta-analysis of young-populations (age 7-20) only.
See this image and copyright information in PMC

Comment in

  • Microbiota: Reseeding the gut.
    Drew L. Drew L. Nature. 2016 Dec 21;540(7634):S109-S112. doi: 10.1038/540S109a. Nature. 2016. PMID: 28002392 No abstract available.
  • Letter to the Editor.
    ECCO Governing Board. ECCO Governing Board. J Crohns Colitis. 2022 Nov 23;16(11):1792-1793. doi: 10.1093/ecco-jcc/jjab225. J Crohns Colitis. 2022. PMID: 35073577 No abstract available.

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