Efficacy of faecal microbiota transplantation in Crohn’s disease: a new target treatment?

Abstract

Summary The efficacy of faecal microbiota transplantation (FMT) in Crohn’s disease (CD) remains unclear due to lack of data. This study aimed to assess the value of FMT in treating CD‐related clinical targets. The use of FMT for CD as a registered trial (NCT01793831) was performed between October 2012 and December 2017. Seven therapeutic targets included abdominal pain, diarrhoea, hematochezia, fever, steroid‐dependence, enterocutaneous fistula and active perianal fistula. Each target was recorded as 1 (yes) or 0 (no) during the long‐term follow‐up for each patient. The primary outcome was the rate of improvement in each therapeutic target. Overall, 174 patients completed the follow‐up. The median follow‐up duration was 43 (interquartile range, 28–59) months. The median score of the total targets was 2 (range, 1–4) before FMT, and it decreased significantly at 1, 3, 6, 12, 24 and 36 months after FMT (P < 0.001 respectively). At 1 month after FMT, 72.7% (101/139), 61.6% (90/146), 76% (19/25) and 70.6% (12/17) of patients achieved improvement in abdominal pain, diarrhoea, hematochezia and fever respectively. Furthermore, 50% (10/20) of steroid‐dependent patients achieved steroid‐free remission after FMT. The present findings indicate that it is important to understand the efficacy of FMT in CD as a targeted therapy, especially for abdominal pain, hematochezia, fever and diarrhoea.

Profound remission in Crohn’s disease requiring no further treatment for 3–23 years: a case series

“…This is composed of an abundance of detrimental bacterial species, such as Enterobacteriaceae (facultative anaerobic bacteria) and a corresponding reduction of beneficial species such as Bacteroides, and firmicutes [22]. Faecal Microbiota Transplantation (FMT), the introduction of healthy human donor stool into the bowel of the recipient, has been suggested as a possible ideal therapeutic agent to restore gut flora imbalances in CD [23]. To date, small studies have shown inconsistent results of FMT in CD and the therapeutic effects are less than that seen in Ulcerative Colitis or Clostridioides difficile infection, for reasons currently unknown [24].…”

Fecal microbiota transplantation in inflammatory bowel disease patients: A systematic review and meta-analysis

“…The stool type subgroup analysis revealed clinical remission rates of 29.1% for fresh fecal material [ 17 – 20 , 22 – 26 , 28 – 32 , 35 , 38 , 42 , 46 , 47 , 51 , 52 ], 44.2% for frozen fecal material [ 21 , 27 , 39 , 45 , 49 , 50 ], 57.2% when both types of stool were used [ 36 , 48 , 53 ], and 66.5% for capsules [ 37 , 43 ], with a statistical difference observed among the groups ( p = 0.036). Two articles did not report the type of stool used for the FMT [ 33 , 34 ] ( Table 2 , S4 Fig ).…”

Fecal Microbiota Transplantation for the Treatment of Inflammatory Bowel Disease: An Update

“…On the contrary, the CRP level increased at 6 weeks in the control group (p = 0.008) but not in the FMT group (p = 0.5) (Sokol et al, 2020). Xiang et al (2020) believed that FMT in CD against targeted therapeutics was efficient, especially hematochezia, abdominal pain, diarrhoea and fever. Whereas, Further research needs to be conduced to gain more high-quality data and provide conclusions with respect to the use of FMT for these patients and subsequently which CD phenotypes are most likely to benefit.…”

“…There are currently several active trials studying the effectiveness of FMT for CD, and the results are diverse ( Table 2) (Cui et al, 2015;Suskind et al, 2015;Wei et al, 2015;Vaughn et al, 2016;Vermeire et al, 2016;Goyal et al, 2018;Gutin et al, 2019;Sokol et al, 2020;Xiang et al, 2020). Xiang et al (2020) studied 174 CD patients treated with FMT via Mid-gut including nasojejunal tube, endoscopy and mid-gut TET (except one through colonic TET). At 1 month after FMT, 76% (19/25), 72.7% (101/139), 70.6% (12/17) and 61.6% (90/146) of patients achieved improvement in hematochezia, abdominal pain, fever and diarrhoea respectively.…”

“… Xiang et al. (2020) believed that FMT in CD against targeted therapeutics was efficient, especially hematochezia, abdominal pain, diarrhoea and fever.…”