Malik Sheza, Naqvi Syed Arsalan Ahmed, Shadali Abul Hasan, Khan Hajra, Christof Michael, Niu Chengu, Schwartz David A, Adler Douglas G
Internal Medicine, Rochester General Hospital, Rochester, NY, USA.
Medical Oncology, Mayo Clinic, Phoenix, AZ, USA.
Dig Dis Sci. 2025 May;70(5):1873-1896. doi: 10.1007/s10620-025-08946-8. Epub 2025 Mar 4.
Recent systematic reviews and meta-analyses (SRMAs) have shown inconsistent effectiveness of FMT among patients with IBD. This study aimed to appraise the evidence for clinically relevant outcomes with FMT in patients with IBD using published SRMAs.
We searched major databases from inception through Nov 2023 to identify SRMAs assessing the effectiveness of FMT in patients with IBD. Primary outcomes included clinical remission, clinical response, endoscopic remission/response, a composite endpoint, and adverse effects. We included SRMAs investigating FMT's effect in patients with IBD using RCTs and observational studies data. Methodological quality and evidence certainty were assessed using AMSTAR 2 and GRADE.
Out of 106 citations, 16 SRMAs were included with varying study sizes (2 to 60 primary studies) and participants (112 to 1169 per SRMA). Five SRMAs assessed FMT in IBD, while 11 focused on Ulcerative Colitis (UC). Seven SRMAs included RCTs only, and nine included both RCTs and observational studies. Methodological quality was critically low in 9 SRMAs (56%) and low in 7 studies (44%). FMT showed clinical remission benefit in all 16 SRMAs, with varying certainty: 3 high, 4 moderate, 4 low, and 5 very low. Endoscopic remission/response was reported in 5 meta-analyses on UC, with 1 high, 3 moderate, and 1 very low certainty. Combined clinical remission and endoscopic response were reported in 3 SRMAs on UC, with 1 low and 2 moderate certainty. Adverse events were reported in 6 SRMAs, with 1 high, 3 moderate, 1 low, and 1 very low certainty.
Current evidence shows potential benefits of FMT in IBD, particularly UC, supported by significant associations in 16 meta-analyses. However, poor methodological quality and variability in evidence certainty call for high-quality RCTs to strengthen the evidence.
近期的系统评价和荟萃分析（SRMA）显示，粪菌移植（FMT）在炎症性肠病（IBD）患者中的有效性存在不一致的情况。本研究旨在利用已发表的SRMA评估IBD患者接受FMT后临床相关结局的证据。
我们检索了从数据库建立至2023年11月的主要数据库，以识别评估FMT在IBD患者中有效性的SRMA。主要结局包括临床缓解、临床反应、内镜缓解/反应、复合终点和不良反应。我们纳入了使用随机对照试验（RCT）和观察性研究数据调查FMT对IBD患者影响的SRMA。使用AMSTAR 2和GRADE评估方法学质量和证据确定性。
在106篇文献中，纳入了16项SRMA，研究规模各异（2至60项原始研究），参与者数量也不同（每项SRMA有112至1169名）。5项SRMA评估了FMT在IBD中的应用，11项聚焦于溃疡性结肠炎（UC）。7项SRMA仅纳入了RCT，9项同时纳入了RCT和观察性研究。9项SRMA（56%）的方法学质量极低，7项研究（44%）的方法学质量低。在所有16项SRMA中，FMT均显示出临床缓解益处，确定性各异：3项高、4项中、4项低和5项极低。5项关于UC的荟萃分析报告了内镜缓解/反应，确定性为1项高、3项中、1项极低。3项关于UC的SRMA报告了综合临床缓解和内镜反应，确定性为1项低和2项中。6项SRMA报告了不良事件，确定性为1项高、3项中、1项低和1项极低。
目前的证据表明FMT在IBD，尤其是UC中具有潜在益处，16项荟萃分析中的显著关联支持了这一点。然而，方法学质量差和证据确定性的变异性需要高质量RCT来加强证据。
