Tuo Chen1, Qun Zhou2, Dan Zhang1, Feng Jiang1, Jing Wu3, Jin-Yong Zhou3, Xiao Zheng4, Yu-Gen Chen1. 1. Department of Colorectal Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China. 2. Department of Anesthesiology, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu, China. 3. Central Laboratory, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China. 4. Department of Pharmacy, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Abstract
BACKGROUND: Evidence concerning the effect of faecal microbiota transplantation [FMT] in Clostridium difficile infection [CDI] patients with inflammatory bowel disease [IBD] has not been firmly established. Therefore, we performed a systematic review and meta-analysis to evaluate FMT treatment outcomes in patients with IBD treated for CDI. METHODS: An electronic search of four databases was conducted until November 1, 2017. Cohort studies of FMT efficacy and safety in CDI patients with IBD were included. Pooled effect sizes were calculated with 95% confidence intervals [CI] using a random-effects model. RESULTS: Nine cohort studies comprising a total of 346 CDI patients with IBD were included. The initial cure rate was 81% [95% CI = 76%-85%] and the overall cure rate was up to 89% [95% CI = 83%-93%], both with no significant heterogeneity. The recurrence rate was 19% [95% CI = 13%-27%] with moderate heterogeneity [Cochran's Q, p = 0.19; I2 = 33%]. There was no significant difference in the CDI cure rate after FMT in patients with and without IBD (risk ratio [RR] = 0.92; 95% CI = 0.81-1.05; Cochran's Q, p = 0.06; I2 = 53%). Subgroup analysis revealed a similar CDI treatment effects after FMT in patients with Crohn's disease and in those with ulcerative colitis [p = 0.1804]. Four studies reported adverse events of IBD flares. CONCLUSIONS: FMT is an effective therapy for CDI in patients with IBD. Well-designed randomised controlled trials and well-conducted microbiological studies are needed to validate its efficacy and safety.
BACKGROUND: Evidence concerning the effect of faecal microbiota transplantation [FMT] in Clostridium difficile infection [CDI] patients with inflammatory bowel disease [IBD] has not been firmly established. Therefore, we performed a systematic review and meta-analysis to evaluate FMT treatment outcomes in patients with IBD treated for CDI. METHODS: An electronic search of four databases was conducted until November 1, 2017. Cohort studies of FMT efficacy and safety in CDI patients with IBD were included. Pooled effect sizes were calculated with 95% confidence intervals [CI] using a random-effects model. RESULTS: Nine cohort studies comprising a total of 346 CDI patients with IBD were included. The initial cure rate was 81% [95% CI = 76%-85%] and the overall cure rate was up to 89% [95% CI = 83%-93%], both with no significant heterogeneity. The recurrence rate was 19% [95% CI = 13%-27%] with moderate heterogeneity [Cochran's Q, p = 0.19; I2 = 33%]. There was no significant difference in the CDI cure rate after FMT in patients with and without IBD (risk ratio [RR] = 0.92; 95% CI = 0.81-1.05; Cochran's Q, p = 0.06; I2 = 53%). Subgroup analysis revealed a similar CDI treatment effects after FMT in patients with Crohn's disease and in those with ulcerative colitis [p = 0.1804]. Four studies reported adverse events of IBD flares. CONCLUSIONS: FMT is an effective therapy for CDI in patients with IBD. Well-designed randomised controlled trials and well-conducted microbiological studies are needed to validate its efficacy and safety.
Authors: Maribeth R Nicholson; Erin Alexander; Sonia Ballal; Zev Davidovics; Michael Docktor; Michael Dole; Jonathan M Gisser; Alka Goyal; Suchitra K Hourigan; M Kyle Jensen; Jess L Kaplan; Richard Kellermayer; Judith R Kelsen; Melissa A Kennedy; Sahil Khanna; Elizabeth D Knackstedt; Jennifer Lentine; Jeffery D Lewis; Sonia Michail; Paul D Mitchell; Maria Oliva-Hemker; Tiffany Patton; Karen Queliza; Sarah Sidhu; Aliza B Solomon; David L Suskind; Madison Weatherly; Steven Werlin; Edwin F de Zoeten; Stacy A Kahn Journal: J Crohns Colitis Date: 2022-06-24 Impact factor: 10.020
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