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Review
. 2021 Apr 23:2021:6612970.
doi: 10.1155/2021/6612970. eCollection 2021.

Fecal Microbiota Transplantation as Therapy for Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis

Xiaolei Liu  1 , Yan Li  1   2 , Kaichun Wu  3 , Yongquan Shi  3 , Min Chen  3
Affiliations
Review

Fecal Microbiota Transplantation as Therapy for Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis

Xiaolei Liu et al. Gastroenterol Res Pract. .

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.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of search strategy.
Figure 2
Figure 2
Risk of bias of included studies.
Figure 3
Figure 3
Forest plot of studies reporting combined clinical remission with endoscopic remission/response and subgroup analysis according to different delivery routes.
Figure 4
Figure 4
Forest plot of studies reporting combined clinical remission with endoscopic remission/response and subgroup analysis according to number of donors.
Figure 5
Figure 5
Forest plot of studies reporting combined clinical remission with endoscopic remission/response and subgroup analysis according to frequency of FMT administration.
Figure 6
Figure 6
Forest plot of studies reporting clinical remission and subgroup analysis according to different delivery routes.
Figure 7
Figure 7
Forest plot of studies reporting clinical remission and subgroup analysis according to number of donors.
Figure 8
Figure 8
Forest plot of studies reporting clinical remission and subgroup analysis according to frequency of FMT administration.
Figure 9
Figure 9
Forest plot of studies reporting endoscopic remission and subgroup analysis according to different delivery routes.
Figure 10
Figure 10
Forest plot of studies reporting endoscopic remission and subgroup analysis according to number of donors.
Figure 11
Figure 11
Forest plot of studies reporting endoscopic remission and subgroup analysis according to frequency of FMT administration.
Figure 12
Figure 12
Forest plot of studies reporting serious adverse events and subgroup analysis according to different delivery routes.
Figure 13
Figure 13
Forest plot of studies reporting serious adverse events and subgroup analysis according to number of donors.
Figure 14
Figure 14
Forest plot of studies reporting serious adverse events and subgroup analysis according to frequency of FMT administration.
See this image and copyright information in PMC

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