Current Evidence for the Management of Inflammatory Bowel Diseases Using Fecal Microbiota Transplantation
Purpose of Review
Fecal microbiota transplantation (FMT) has been investigated as a potential treatment for inflammatory bowel disease (IBD). This review examines current evidence around the efficacy and safety of FMT for patients with IBD.
Randomized controlled trials (RCTs) and meta-analyses have suggested that FMT may facilitate clinical and endoscopic remission in patients with active ulcerative colitis (UC). Although the evidence for FMT in Crohn’s disease (CD) is more limited, positive outcomes have been observed in small cohort studies. Most adverse events (AEs) were mild and included transient gastrointestinal symptoms. Serious adverse events (SAEs) did not differ significantly between the FMT and control groups, and a marginal increased rate of IBD flares following FMT was observed. Microbiota analysis following FMT showed increased intestinal bacterial diversity and a shift towards the donor microbial profile in recipients’ stools.
FMT for patients with IBD is promising as RCTs have shown the benefit of FMT for UC, although the efficacy of FMT for CD is less clear. Further large and well-designed trials are necessary to resolve critical issues such as the donor selection, the ideal route of administration, duration, frequency of FMT, and the long-term sustained efficacy and safety.
KeywordsFecal microbiota transplantation Inflammatory bowel disease Ulcerative colitis Crohn’s disease
Compliance with Ethical Standards
Conflict of Interest
Seong Ran Jeon, Jocelyn Chai, Christiana Kim, and Christine H. Lee declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 10.•• Costello SWBR, Katsikeros R, et al. Short duration, low intensity pooled faecal microbiota transplantation induces remission in patients with mild-moderately active ulcerative colitis: a randomised controlled trial. J Crohns Colitis. 2017;11(suppl 1):S23. The RCT on FMT for IBD. CrossRefGoogle Scholar
- 13.• Paramsothy S, Paramsothy R, Rubin DT, et al. Faecal microbiota transplantation for inflammatory bowel disease: a systematic review and meta-analysis. J Crohns Colitis. 2017;11(10):1180–99. This article updates the current evidences on FMT in the various IBD subtypes by performing meta-analyses. CrossRefPubMedGoogle Scholar
- 14.• Narula N, Kassam Z, Yuan Y, et al. Systematic review and meta-analysis: fecal microbiota transplantation for treatment of active ulcerative colitis. Inflamm Bowel Dis. 2017;23(10):1702–9. This meta-analysis using only RCTs demonstrates that the use FMT for UC is beneficial. CrossRefPubMedGoogle Scholar
- 25.Gianotti RJ, Moss AC. Fecal microbiota transplantation: from Clostridium difficile to inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2017;13(4):209–13.Google Scholar
- 26.• Allegretti J, Eysenbach LM, El-Nachef N, Fischer M, Kelly C, Kassam Z. The current landscape and lessons from fecal microbiota transplantation for inflammatory bowel disease: past, present, and future. Inflamm Bowel Dis. 2017;23(10):1710–7. This review offers the current evidences on the efficacy and safety of FMT for IBD and outline ongoing clinical trials. CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Binion DG. Clostridium difficile infection in patients with inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2012;8(9):615–7.Google Scholar
- 46.Tariq R, Law CCY, Khanna S, Murthy S, McCurdy JD. The impact of Clostridium difficile infection on mortality in patients with inflammatory bowel disease: a systematic review and meta-analysis. J Clin Gastroenterol. 2017. https://doi.org/10.1097/MCG.0000000000000968.
- 51.• Qazi T, Amaratunga T, Barnes EL, Fischer M, Kassam Z, Allegretti JR. The risk of inflammatory bowel disease flares after fecal microbiota transplantation: systematic review and meta-analysis. Gut Microbes. 2017;8(6):1–15. This article provides a detailed systematic review and meta-analysis on the rate of worsening in IBD following alteration of the host microbiota. CrossRefGoogle Scholar
- 53.Trial of antimicrobials versus placebo in addition to fecal transplant therapy in ulcerative colitis (FMT). ClinicalTrials Web site. https://clinicaltrials.gov/ct2/show/NCT02606032. Updated December 18, 2017. Accessed January 30, 2018.
- 57.Allegretti JFMPE, Elliott RJ, et al. Fecal microbiota transplantation delivered via oral capsules achieves microbial engraftment similar to traitional delivery modalities: safety, efficacy and engraftment results from a multi-center cluster randomized dose-finding study. Gastroenterology. 2016;150:S540.Google Scholar