Kahan Tamara, Chandan Saurabh, Khan Shahab R, Deliwala Smit, Chang Shannon, Axelrad Jordan, Shaukat Aasma
Division of Gastroenterology and Hepatology, NYU Grossman School of Medicine, New York, New York.
Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska.
Gastro Hep Adv. 2023 Apr 25;2(6):843-852. doi: 10.1016/j.gastha.2023.04.005. eCollection 2023.
Pouchitis is the most common long-term complication after ileal-pouch anal anastomosis in patients with ulcerative colitis. We conducted a systematic review and meta-analysis evaluating the safety and efficacy of fecal microbiota transplant (FMT) in chronic antibiotic dependent and refractory pouchitis.
Multiple databases were searched through April 2022 for studies that reported the efficacy and safety of FMT in patients with chronic pouchitis. Meta-analysis using random effects model was performed to calculate pooled rates.
Eight studies with a total of 89 patients were included in our review, with 74 patients having received FMT and 15 patients having received placebo. The mean age ranged from 32.6 to 51.5 years. In patients that received FMT, the pooled rates of overall remission was (Pouchitis Disease Activity Index score < 7) 22% (95% CI, 9%-43%; I, 29%), clinical remission was 20% (95% CI, 6%-49%; I, 25%), clinical response rate was 42% (95% CI, 30%-54%; I, 7%), and the relapse rate 60% (95% CI, 40%-77%, I 16%) over the mean follow up of 4.67 months (range 1-12 months). The pooled proportion of patients with adverse events was 54% (95% CI, 21%-84%; I, 73%). There were no serious adverse events or deaths.
In patients with chronic pouchitis, FMT is safe though there are mixed results in terms of its long-term efficacy. Future Randomized Controlled Trials with larger sample sizes and greater standardization in terms of preparation, delivery, and length of treatment of FMT are needed to determine efficacy.
袋炎是溃疡性结肠炎患者回肠袋肛管吻合术后最常见的长期并发症。我们进行了一项系统评价和荟萃分析，以评估粪便微生物群移植（FMT）在慢性抗生素依赖型和难治性袋炎中的安全性和有效性。
检索多个数据库至2022年4月，查找报告FMT治疗慢性袋炎患者疗效和安全性的研究。采用随机效应模型进行荟萃分析以计算合并率。
我们的综述纳入了8项研究，共89例患者，其中74例接受了FMT，15例接受了安慰剂。平均年龄在32.6至51.5岁之间。接受FMT的患者中，总体缓解率（袋炎疾病活动指数评分<7）的合并率为22%（95%CI，9%-43%；I²，29%），临床缓解率为20%（95%CI，6%-49%；I²，25%），临床反应率为42%（95%CI，30%-54%；I²，7%），在平均4.67个月（范围1-12个月）的随访中复发率为60%（95%CI，40%-77%，I² 16%）。不良事件患者的合并比例为54%（95%CI，21%-84%；I²，73%）。没有严重不良事件或死亡。
在慢性袋炎患者中，FMT是安全的，但其长期疗效结果不一。未来需要进行样本量更大、FMT制备、给药和治疗时长方面标准化程度更高的随机对照试验来确定疗效。
