Cheng F, Huang Z, Wei W, Li Z
Division of Gastroenterology, Zigong First People's Hospital, 42 Shangyihao Road, Zigong, 643000, Sichuan, China.
Tech Coloproctol. 2021 May;25(5):495-504. doi: 10.1007/s10151-020-02395-3. Epub 2021 Mar 23.
Crohn's disease (CD) is a chronic idiopathic inflammatory intestinal disorder associated with fecal dysbiosis. Fecal microbiota transplantation (FMT) is an emerging treatment approach for CD. But its efficacy and safety remain controversial. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of FMT in CD patients.
Electronic databases were searched for studies that reported efficacy and/or safety of FMT for CD. Clinical remission was established as the primary outcome. Secondary outcome was clinical response. Odds ratios with 95% confidence intervals (CIs) were reported.
In all, 12 trials were included in our study. Pooled analysis showed that 0.62 (95% CI 0.48, 0.81) of CD patients achieved clinical remission and 0.79 (95% CI 0.71, 0.89) of CD patients achieved clinical response post-FMT. Sub-analyses suggested the rate of clinical remission with fresh stool FMT was higher than with frozen stool FMT (73% vs 43%; p < 0.05). Most adverse events were minor and self-resolving and no major FMT-related adverse event has been reported so far.
The evidence showed that FMT is an effective and safe therapy for CD. FMT may be successful because it increases the overall diversity of enteric microbiome. Additional randomized controlled studies are needed.
克罗恩病（CD）是一种与粪便微生物群失调相关的慢性特发性炎症性肠病。粪便微生物群移植（FMT）是一种新兴的CD治疗方法。但其疗效和安全性仍存在争议。我们进行了一项系统评价和荟萃分析，以评估FMT对CD患者的疗效和安全性。
检索电子数据库中报告FMT治疗CD疗效和/或安全性的研究。将临床缓解确定为主要结局。次要结局为临床反应。报告95%置信区间（CI）的比值比。
我们的研究共纳入12项试验。汇总分析显示，FMT后0.62（95%CI 0.48，0.81）的CD患者实现了临床缓解，0.79（95%CI 0.71，0.89）的CD患者实现了临床反应。亚组分析表明，新鲜粪便FMT的临床缓解率高于冷冻粪便FMT（73%对43%；p<0.05）。大多数不良事件轻微且可自行缓解，目前尚未报告与FMT相关的重大不良事件。
证据表明，FMT是一种治疗CD的有效且安全的疗法。FMT可能成功是因为它增加了肠道微生物群的总体多样性。需要更多的随机对照研究。
