Published online May 7, 2015. doi: 10.3748/wjg.v21.i17.5359
Peer-review started: September 30, 2014
First decision: October 14, 2014
Revised: November 19, 2014
Accepted: February 11, 2015
Article in press: February 11, 2015
Published online: May 7, 2015
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.
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.
Core tip: Aberrancies in the host’s microbiota have been found in several diseases. The most radical way to modulate the microbiota is by fecal microbiota transplantation (FMT). FMT is already used for various diseases while evidence from randomized studies is only just emerging. We systematically reviewed the efficacy of FMT in Clostridium difficile infection (CDI), inflammatory bowel disease, constipation, irritable bowel syndrome, pouchitis, and metabolic syndrome. FMT could be incorporated in clinical practice for CDI; patients with other indications should currently only be treated in clinical trials. Upcoming randomized studies on the long-term efficacy and safety of FMT will be helpful in the implication of FMT in clinical practice.