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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2018 January-February;177(1-2):26-41
DOI: 10.23736/S0393-3660.17.03482-9
Copyright © 2017 EDIZIONI MINERVA MEDICA
lingua: Inglese
Fecal microbiota transplantation as a treatment for gastrointestinal diseases: a systemic review and meta-analysis
Tanwei YUAN 1 ✉, Zhaoji LI 2
1 School of Public Health, Medical College of Soochow University, Soochow University, Suzhou City, China; 2 School of Clinical Medicine, Medical College of Soochow University, Soochow University, Suzhou City, China
INTRODUCTION: Fecal microbiota transplantation (FMT) is a novel therapy for many gastrointestinal (GI) diseases, but its efficacy and safety have not reached consensus. We aimed to retrospect the application of FMT on various GI diseases and appraise its efficacy and safety. EVIDENCE ACQUISITION: We searched PubMed, Embase, BioMed, Web of Science, and Chinese wanfang databases updated to May 2016.
EVIDENCE SYNTHSIS: Effective rate of FMT was defined as the portion of patient who achieved therapeutic effect and was analyzed per disease category. We included 41 studies: 23 on Clostridium difficile infection (CDI), 14 on inflammatory bowel disease (IBD), 1 on irritable bowel syndrome (IBS), 1 on methicillin-resistant Staphylococcus aureus (MRSA) enterocolitis, 1 on chronic refractory pouchitis and 1 on slow-transit constipation (SCT).
EVIDENCE ACQUISITION: The meta-analysis was conducted on studies with high methodological quality, and the pooled success/remission rate of FMT was 91%, 95% CI: 89%-93% in CDI (test for heterogeneity: Cochran’s Q, P=0.9395; I2 = 0%) and 29%, 95% CI: 22-38% in IBD (Cochran’s Q, P=0.1959; I2 = 26.1%). Effective rate of FMT were 75% in IBS (N.=12), 100% in enterocolitis (N.=5) and 37.5% in STC (N.=24) respectively. In pouchitis (N.=8), none of the patients achieved remission. Severe adverse events were rare.
CONCLUSIONS: FMT is basically safe in the short term. FMT achieves the greatest success in CDI, and carries the therapeutic potential in IBD, but the evidence on other GI diseases is weak.
KEY WORDS: Fecal microbiota transplantation - Gastrointestinal diseases - Clostridium difficile - Inflammatory bowel diseases - Meta-analysis