Zhejiang Chinese Medical University.
Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Medicine (Baltimore). 2021 Apr 9;100(14):e25390. doi: 10.1097/MD.0000000000025390.
Functional constipation is a prevalent, burdensome gastrointestinal disorder whose treatment remains challenging. Combined therapy uniting multiple treatments may be promising. Fecal microbiota transplantation (FMT) which tends to be an etiological treatment has been increasingly investigated in its management. Meanwhile, laxatives are widely used to relieve constipation temporarily, but their overall efficacy is poor. Therefore, we performed meta-analyses of randomized controlled trials to evaluate the joint efficacy of FMT and laxatives in functional constipation.
We performed a systematic literature search of 6 electronic databases as of August 11, 2020. Randomized controlled trial of FMT together with laxatives vs laxatives alone in functional constipation in adults were included. Two reviewers independently performed the screening, data extraction, and bias assessment. Dichotomous outcome data were synthesized by risk ratio, and measurement data by weighted mean difference (WMD).
A total of 1400 records were identified, of which 5 were eligible (409 patients). Overall, compared to laxatives alone, combined therapy of FMT and laxatives more significantly improved total effective rate (risk ratio: 1.35; 95% confidence interval [CI]: 1.14, 1.60; I2 = 13%), Bristol stool form scale score (WMD: 1.04; 95% CI: 0.57, 1.51; I2 = 76%), reduce Wexner score (WMD: -3.25; 95% CI: -5.58, -0.92; I2 = 92%), Knowles-Eccersley-Scott-Symptom (KESS) score (WMD: -5.65; 95% CI: -7.62, -3.69; I2 = 0%) and patient assessment of constipation quality of life score (WMD: -18.56; 95%; CI: -26.43, -10.68; I2 = 78%). No serious adverse events were reported. The majority of included studies had poor methodological quality.
Combined therapy of FMT and laxatives may be a reasonably effective and safe treatment for people with functional constipation. However, caution is needed with the interpretation of these data due to the small sample size, high heterogeneity, and low quality of the studies. Besides, we expect that more studies will be performed exploring the efficacy and safety of combined therapy for functional constipation.
功能性便秘是一种普遍存在且负担沉重的胃肠道疾病，其治疗仍然具有挑战性。联合多种治疗方法的综合治疗可能具有前景。粪菌移植（FMT）作为一种病因治疗方法，在其治疗管理中得到了越来越多的研究。同时，泻药被广泛用于暂时缓解便秘，但总体疗效较差。因此，我们对随机对照试验进行了荟萃分析，以评估 FMT 和泻药联合治疗功能性便秘的疗效。
我们对截至 2020 年 8 月 11 日的 6 个电子数据库进行了系统文献检索。纳入成人功能性便秘中 FMT 联合泻药与单独使用泻药的随机对照试验。两名审查员独立进行筛选、数据提取和偏倚评估。二分类结局数据采用风险比进行综合，测量数据采用加权均数差（WMD）进行综合。
共确定了 1400 条记录，其中 5 条符合条件（409 例患者）。总体而言，与单独使用泻药相比，FMT 和泻药联合治疗更显著地提高了总有效率（风险比：1.35；95%置信区间[CI]：1.14，1.60；I2=13%）、布里斯托尔粪便形态量表评分（WMD：1.04；95%CI：0.57，1.51；I2=76%）、降低 Wexner 评分（WMD：-3.25；95%CI：-5.58，-0.92；I2=92%）、Knowles-Eccersley-Scott-Symptom（KESS）评分（WMD：-5.65；95%CI：-7.62，-3.69；I2=0%）和患者便秘生活质量评分（WMD：-18.56；95%CI：-26.43，-10.68；I2=78%）。未报告严重不良事件。大多数纳入的研究方法学质量较差。
FMT 和泻药联合治疗可能是治疗功能性便秘的一种合理有效且安全的方法。但是，由于研究样本量小、异质性高以及研究质量低，需要谨慎解释这些数据。此外，我们希望进行更多的研究来探索联合治疗功能性便秘的疗效和安全性。
