Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
J Gastroenterol Hepatol. 2021 Oct;36(10):2672-2686. doi: 10.1111/jgh.15598. Epub 2021 Jul 6.
The gastrointestinal microbiota is the key antigenic drive in the inflammatory bowel diseases. Randomized controlled trials (RCTs) in ulcerative colitis have established fecal microbiota transplantation (FMT) as an effective therapy. We have conducted a systematic review to evaluate the efficacy of FMT in Crohn's disease.
A systematic literature search was performed through to August 2020 (MEDLINE; Embase). Studies were included if they reported FMT administration in patients with Crohn's disease, and reported on clinical outcomes.
Fifteen studies published between 2014 and 2020, comprising 13 cohort studies and two RCTs, were included in the analysis. The majority of trials evaluated FMT for induction of remission, with follow-up duration varying from 4 to 52 weeks. One RCT in 21 patients, of single-dose FMT versus placebo, following steroid-induced remission, showed a higher rate of steroid-free clinical remission in the FMT group compared to the control group: 87.5% vs 44.4% at week 10 (P = 0.23). Another RCT, two-dose FMT in 31 patients, showed an overall clinical remission rate of 36% at week 8, however, with no difference in clinical or endoscopic endpoints between FMT administered by gastroscopy and colonoscopy. Considering all studies, the clinical response rates in early follow up were higher following multiple FMT than with single FMT. FMT dose did not appear to influence clinical outcomes, nor did whether FMT was fresh or frozen. FMT delivered via upper gastrointestinal route demonstrated higher early efficacy rates of 75 to 100% compared with lower delivery route rates of 30% to 58%, but on follow up beyond 8 weeks, this difference was not maintained. Whether pre-FMT antibiotic administration was beneficial was not able to be determined due to the limited number of patients receiving antibiotics and varying antibiotic regimens. No serious adverse events were reported.
Preliminary studies suggest that FMT may be an effective therapy in Crohn's disease. However large controlled trials are needed. No serious safety concerns have been identified.
胃肠道微生物群是炎症性肠病的关键抗原驱动因素。溃疡性结肠炎的随机对照试验（RCT）已经确立粪便微生物群移植（FMT）是一种有效的治疗方法。我们进行了系统评价，以评估 FMT 在克罗恩病中的疗效。
通过 MEDLINE；Embase 进行了系统文献检索，直到 2020 年 8 月。如果研究报告了 FMT 在克罗恩病患者中的应用，并报告了临床结局，则纳入研究。
15 项发表于 2014 年至 2020 年的研究，包括 13 项队列研究和 2 项 RCT，被纳入分析。大多数试验评估了 FMT 对缓解的诱导，随访时间从 4 周到 52 周不等。一项 RCT 纳入 21 例患者，给予单剂量 FMT 与安慰剂，用于治疗类固醇诱导的缓解，结果显示 FMT 组比对照组在第 10 周时达到无类固醇临床缓解的比例更高：87.5%比 44.4%（P=0.23）。另一项 RCT 纳入 31 例患者，给予两剂量 FMT，第 8 周时总临床缓解率为 36%，但内窥镜和临床终点无差异，接受胃镜和结肠镜下 FMT 治疗的患者之间无差异。考虑所有研究，在早期随访中，多次 FMT 的临床反应率高于单次 FMT。FMT 剂量似乎不会影响临床结局，也不会影响 FMT 是新鲜的还是冷冻的。上消化道途径的 FMT 早期疗效较高，为 75%至 100%，而下消化道途径的疗效为 30%至 58%，但在 8 周以上的随访中，这种差异不再维持。由于接受抗生素治疗的患者数量有限，且抗生素方案不同，因此无法确定 FMT 前使用抗生素是否有益。未报告严重不良事件。
初步研究表明，FMT 可能是克罗恩病的一种有效治疗方法。然而，需要进行大规模的对照试验。目前尚未发现严重的安全问题。
