A Meta-analysis Of The Efficacy And Related Factors Of Fecal Microbiota Transplantation For Crohn’s Disease

Background:Crohn’s disease(CD)is a chronic,recurrent and nonspecific transmural inflammation of the digestive tract.The disease is segmental and can affect any part of the digestive tract.Among them,terminal ileum and the right colon are the most commonly affected.The etiology and pathogenesis of CD are still unknown.Genetics,immunity,intestinal flora and their interactions are generally considered to be the major risk factors for CD.CD is recurrent and not easy to cure,and usually have a long disease course.CD is a benign disease,but there is still a lack of effective treatment.In recent years,fecal bacteria transplantation(fecal microbiota transplantation,FMT)gradually caught people’s attention,which has showed very good treatment effect in difficult clostridium infection and ulcerative colitis(UC).So systematically evaluate the efficacy and safety of FMT for CD is of great significance for the treatment of patients with CD in the future,which provides a new train of thought for the CD treatment.Objective:To systematically evaluate the efficacy and safety of fecal bacteria transplantation in the treatment of crohn’s disease and the possible related factors.Methods:English databases such as Pubmed,Embase,Web of Science,Ebsco,The Cochrane library,Medline and Chinese databases such as CNKI,WANFANG,CBM and VIP were systematically searched.The retrieval words in English were"Crohn’s disease","CD","inflammatory bowel disease","IBD","fecal microbiota transplantation","FMTM","fecal bacteriotherapy","intestinal microbiota transplantation","IMT".The retrieval scope was published before February 28,2020,and included theclinical trials of fecal bacteria transplantation for crohn’s disease.Meta analysis was performed using STATA software.Results:A total of 9 studies were included,including 1 randomized controlled trial and 8 non-randomized controlled trials.Since there was only one randomized controlled trial,and it was a comparison of fecal transplantation routes,this RCT was not analyzed separately.A meta-analysis of the single rates of the 9 included studies showed that the overall short-term response rate of FMT for CD was 73%(95%CI:62%～85%)and the overall short-term clinical remission rate was 57%(95%CI:42%～72%).The overall long-term clinical remission rate was 49%(95%CI:36%～62%).Subgroup analysis showed that the short-term clinical remission rate of children group was higher than that of adults group(78%vs 55%),p=0.535,and the difference was not statistically significant.The short-term clinical remission rates of the donor-associated group,the unrelated group and the uncertain group were 78%,41%and 70%,respectively(p=0.362),and the difference was not statistically significant.The short-term clinical remission rate of fresh feces group was higher than that of frozen feces group(61%vs 31%),p=0.499,and the difference was not statistically significant.The short-term clinical remission rate of the group with antibiotic pretreatment was higher than that of the group without antibiotic pretreatment(78%vs 66%),p=0.644,and the difference was not statistically significant.The short-term clinical remission rate of the middle gastrointestinal transplantation group was higher than that of the lower gastrointestinal transplantation group(69%vs 42%),p=0.098,and the difference was not statistically significant.The short-term clinical response rate of the multiple fecal transplantation group was higher than that of the single fecal transplantation group(60%vs 56%),p=0.341,and the difference was not statistically significant.On the whole,the incidence of serious adverse reactions was less.There were mostly transient changes which mostly related to endoscopic operations,such as sore throat and abdominal pain.Conclusion:FMT has significant efficacy and high safety for CD.It is a good choice for CD patients who are prone to relapse and have poor efficacy after trying a variety of drugs.The effect of FMT for CD was independent of age,donor selection,fecal treatment,transplantation route,transplantation frequency and antibiotic pretreatment.But the conclusions above need to be further verified by further controlled studies,especially RCT studies.