Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2015; 21(17): 5359-5371
Published online May 7, 2015. doi: 10.3748/wjg.v21.i17.5359
Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review
Noortje G Rossen, John K MacDonald, Elisabeth M de Vries, Geert R D'Haens, Willem M de Vos, Erwin G Zoetendal, Cyriel Y Ponsioen
Noortje G Rossen, Elisabeth M de Vries, Cyriel Y Ponsioen, Geert R D’Haens, Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, 1105 AZ Amsterdam, The Netherlands
John K MacDonald, Division of Gastroenterology, Robarts Clinical Trials, Robarts Research Institute, The University of Western Ontario, London, Canada and Amsterdam, The Netherlands, Ontario N6A 5K8, Canada
Willem M de Vos, Departments of Bacteriology and Immunology and Veterinary Biosciences, University of Helsinki, FI-00014 Helsinki, Finland
Willem M de Vos, Erwin G Zoetendal, Laboratory of Microbiology, Wageningen University, 6703 HA Wageningen, The Netherlands
Author contributions: Rossen NG and de Vries EM, assessed articles for eligibility in this review; Rossen NG, MacDonald JK and Ponsioen CY prepared the first draft of the manuscript; in which MacDonald JK was mainly involved in the method section of this draft; Rossen NG and Ponsioen CY finalised the manuscript after comments from MacDonald JK, de Vries EM, D’Haens GR, de Vos WM and Zoetendal EG; Rossen NG completed all tables and figures and performed the statistical analyses of the results; all other authors reviewed results, structured and reviewed the manuscript.
Supported by “Dutch Digestive Foundation” Grant 2011 (WO 11-17) (to Rossen NG).
Conflict-of-interest: The authors declare that they have no commercial, personal, political, intellectual, or religious conflict of interest with respect to this manuscript.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at Dryad repository, who will provide a permanent, citable and open-access home for the dataset.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Noortje G Rossen, MD, Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Room C2-231, 1105 AZ Amsterdam, The Netherlands.
Telephone: +31-20-5662199 Fax: +31-20-5669608
Received: September 30, 2014
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.

Keywords: Fecal microbiota transplantation, Microbiota, Clostridium difficile infection, Inflammatory bowel disease, 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.