Systematic review: faecal microbiota transplantation in the management of inflammatory bowel disease

Abstract

Summary Background The intestinal microbiota is involved in the pathogenesis of inflammatory bowel disease (IBD). Faecal microbiota transplantation (FMT) has been used for the management of IBD as well as infectious diarrhoea. Aim To undertake a systematic review of FMT in patients with IBD. Methods The systematic review followed Cochrane and PRISMA recommendations. Nine electronic databases were searched in addition to hand searching and contacting experts. Inclusion criteria were reports (RCT, nonrandomised trials, case series and case reports) of FMT in patients with IBD. Results Of the 5320 articles identified, 17 fulfilled the inclusion criteria, none of which were controlled trials. There were nine case series/case reports of patients receiving FMT for management of their IBD, and eight where FMT was for the treatment of infectious diarrhoea in IBD. These 17 articles reported on 41 patients with IBD (27 UC, 12 Crohn's, 2 unclassified) with a follow‐up period of between 2 weeks and 13 years. Where reported, FMT was administered via colonoscopy/enema (26/33) or via enteral tube (7/33). In patients treated for their IBD, the majority experienced a reduction of symptoms (19/25), cessation of IBD medications (13/17) and disease remission (15/24). There was resolution of C. difficile infection in all those treated for such (15/15). Conclusions Whilst the available evidence is limited and weak, it suggests that faecal microbiota transplantation has the potential to be an effective and safe treatment for IBD, at least when standard treatments have failed. Well‐designed randomised controlled trials are required to investigate these findings.

The microbiota in inflammatory bowel disease

“…Several studies have been published on the use of FMT in IBD [128]. In one study, FMT was administered via enema in a small group of children and young adults [129], and no serious adverse events were reported.…”

Mechanisms and effectiveness of prebiotics in modifying the gastrointestinal microbiota for the management of digestive disorders

“…There is increasing interest in the use of faecal microbiota transplantation, which has been undertaken by a small number of institutions for many years, despite little robust research evidence. A recent systematic review failed to identify any controlled trials of faecal microbiota transplantation in Crohn's disease (80) . However, case series/case reports of at least six patients receiving faecal microbiota transplantation for the management of Crohn's disease were identified in which the majority experienced considerable disease response (although outcome data for Crohn's disease and ulcerative colitis were combined) (80) .…”

“…A recent systematic review failed to identify any controlled trials of faecal microbiota transplantation in Crohn's disease (80) . However, case series/case reports of at least six patients receiving faecal microbiota transplantation for the management of Crohn's disease were identified in which the majority experienced considerable disease response (although outcome data for Crohn's disease and ulcerative colitis were combined) (80) . Controlled trials of faecal microbiota transplantation in management of active Crohn's disease are warranted.…”

Modulating the microbiota in inflammatory bowel diseases: prebiotics, probiotics or faecal transplantation?

“…An example is the narrow-spectrum Thuricin CD that is produced by Bacillus thuringiensis and has activity against C. diffile (85) . A meta-analysis including nine reports describing FMT in twenty-six patients with IBD concluded that, although the evidence is limited and weak, the majority of the studies suggest that FMT may be an effective treatment option in IBD (86) . A retrospective analysis of sixty-two patients with UC treated with FMT, reported response to FMT in 91·9 % (fifty-seven/sixty-two) of the patients, of which 67·7 % (forty-two/sixty-two) achieved complete remission and 24·2 % (fifteen/ sixty-two) achieved partial response.…”