IBD: fecal transplantation of uncertain benefit in Cochrane review

  • Cochrane Database Syst Rev

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Fecal microbiota transplantation (FMT) from healthy people to the gastrointestinal tract of children or adults with inflammatory bowel disease (IBD) is of uncertain efficacy and safety, according to a Cochrane review.

Why this matters

  • The evidence is insufficient for the introduction of FMT for IBD into clinical practice.

Study design

  • Pooled analysis of 4 randomized controlled trials or nonrandomized trials with a control group (n=277) that met eligibility criteria after search included Medline, EMBASE, Cochrane Library, and Cochrane IBD Group Specialized Register.
  • The quality of the evidence was rated by GRADE criteria.
  • Funding: None.

Key results

  • For ulcerative colitis (UC), FMT may increase the rate of clinical remission at 8 weeks (37% vs 18% with control intervention; risk ratio [RR], 2.03; 95% CI, 1.07-3.86; low-certainty evidence).
  • For UC, FMT may increase rate of endoscopic remission (30% vs 10%; RR, 2.96; 95% CI, 1.60-5.48; low-certainty evidence).
  • FMT nonsignificantly increased severe adverse events (AEs; 7% vs 5%; RR, 1.40; 95% CI, 0.55-3.58; low-certainty evidence), most commonly with Clostridium difficile and cytomegalovirus infections, small bowel perforation, pneumonia.
  • FMT did not increase rate of AEs (78% vs 75%; RR, 1.03; 95% CI, 0.81-1.31; moderate certainty of evidence).

Limitations

  • Small number of studies.
  • No studies of Crohn's disease.

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