Fecal Microbiota Transplantation in the Treatment of Chronic Pouchitis: A Systematic Review

Abstract

The objective was to evaluate available literature on treatment of chronic pouchitis with fecal microbiota transplantation (FMT) focusing on clinical outcomes, safety, and different approaches to FMT preparation and delivery. A systematic review of electronic databases was conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials Library from inception through April 2020. Human studies of all study types reporting results of FMT to treat chronic pouchitis were included. Nine studies, reporting FMT treatment of 69 patients with chronic pouchitis were found eligible for the review. Most studies were case series and cohort studies rated as having fair to poor quality due to high risk of bias and small sample size. Only one randomized controlled trial was included, finding no beneficial effect of FMT. In total clinical response after FMT was reported in 14 (31.8%) out of 44 evaluated patients at various timepoints after FMT, and clinical remission in ten (22.7%) patients. Only minor self-limiting adverse events were reported. FMT varied greatly regarding preparation, length of treatment, and route of delivery. The effects of FMT on symptoms of chronic pouchitis are not established, though some studies show promising results. Future controlled well-designed studies are warranted.

Current Status and Future Therapeutic Options for Fecal Microbiota Transplantation

“…The most recent pouchitis-specific systematic review with meta-analysis included 9 investigations, reporting the FMT treatment of 69 patients. Generally, clinical effectiveness after FMT was reported in 32% of the 44 evaluated patients at various time points after FMT, and clinical remission in 23% of the patients [33].…”

The Role of Fecal Microbiota Transplantation in the Treatment of Inflammatory Bowel Disease

“…Another potential indication for FMT in IBD is pouchitis. It occurs in up to 60% of UC patients after restorative proctocolectomy and is the most common long-term complication in this group [ 93 ]. The exact pathogenesis of pouchitis remains unclear, but dysbiosis seems to be a key factor.…”

“…This hypothesis is supported by differences in the microbiota composition between patients with pouchitis and those with a noninflamed pouch, and the role of antibiotics in the treatment of pouchitis and probiotics in the prevention of relapses [ 94 , 95 ]. A recent systematic review evaluating the role of FMT in the treatment of chronic pouchitis included only nine studies eligible for the review, so reliable data in this indication are limited [ 93 ]. Generally, clinical response to FMT was reported in 14 (31.8%) out of 44 patients at different time points after FMT, and clinical remission in 10 (22.7%) patients.…”

Gastrointestinal microbiome, what is behind faecal microbiota transplantation?

“…Interestingly, subanalyses suggested the rate of clinical remission with fresh stool FMT was higher than with frozen stool FMT (73% vs 43%; p < 0.05) [ 27 ]. A systematic review that included nine studies containing 69 patients with chronic pouchitis showed that FMT has promising results and could be a useful and secure strategy in this scenario [ 28 ]. However, more studies are still needed to provide categorical evidence.…”