Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review

Abstract

AIM:To study the clinical efficacy and safety of Fecal microbiota transplantation (FMT). We systematically reviewed FMT used as clinical therapy. METHODS:We searched MEDLINE, EMBASE, the Cochrane Library and Conference proceedings from inception to July, 2013. Treatment effect of FMT was calculated as the percentage of patients who achieved clinical improvement per patient category, on an intention-to-treat basis. RESULTS:We included 45 studies; 34 on Clostridium difficile -infection (CDI), 7 on inflammatory bowel disease, 1 on metabolic syndrome, 1 on constipation, 1 on pouchitis and 1 on irritable bowel syndrome (IBS). In CDI 90% resolution of diarrhea in 33 case series (n = 867) was reported, and 94% resolution of diarrhea after repeated FMT in a randomized controlled trial (RCT) (n = 16). In ulcerative colitis (UC) remission rates of 0% to 68% were found (n = 106). In Crohn's disease (CD) (n = 6), no benefit was observed. In IBS, 70% improvement of symptoms was found (n = 13). 100% Reversal of symptoms was observed in constipation (n = 3). In pouchitis, none of the patients (n = 8) achieved remission. One RCT showed significant improvement of insulin sensitivity in metabolic syndrome (n = 10). Serious adverse events were rare. SYSTEMATIC REVIEWS CONCLUSION:FMT is highly effective in CDI, and holds promise in UC. As for CD, chronic constipation, pouchitis and IBS data are too limited to draw conclusions. FMT increases insulin sensitivity in metabolic syndrome.

Fecal microbiota transplantation as a method to treat complications after hematopoietic stem cell transplantation

“…A subsequent review article discussed 45 clinical studies (112 patients), showing ambiguous FMT efficiency in inflammatory bowel disease, i.e., only 0 to 68% of the patients achieved clinical remission [22]. The authors noted that possible failure of FMT could be connected, on the one hand, with poor state of donor's microbiota, especially, reduced microbial diversity.…”

Microbiome engineering: Current applications and its future

“…The potential of employing FMT to treat other non-gastrointestinal diseases, such as rheumatoid arthritis, autism and multiple sclerosis, that have been associated with perturbed gut microbiome have also been explored [15]. However, the effect of FMT on these diseases requires further studies.…”

From the intestinal flora to the microbiome

“…To conclude, we would like to briefly mention the possibilities opened by the transplantation of fecal microbiota for the treatment of certain gastrointestinal diseases (57,58). The efficacy of this process has been clearly demonstrated in cases of Clostridium difficile infection (59,60) and it is also beginning to be used in cases of IBD (61).…”