| BACKGROUND Chronic functional constipation(CFC)is a common and frequent clinical functional gastrointestinal disease,and its incidence rate increases year by year,for the progress of social and economic conditions and the improvement of human living standards.Because of disease recurrent and drug dependence,functional constipation not only reduces the standards of the quality of people s lives severely,but also brings huge economic burden to the family and the society.Up to now,a number of research results showed that there was an obvious intestinal flora disorder in patients with constipation.Clinically,by probiotics,prebiotics or synbiotics treatment,the symptoms of constipation are improved to a certain extent,at the same time,no obvious adverse events appear.However,fecal microbiota transplantation(FMT)is a special microecological treatment,which can not only provide beneficial bacteria,but also rebuild the microecological internal environment of the patients'intestines and help the intestines to recover their normal functions.Therefore,in recent years,some researchers have proposed that FMT can be used as a more effective and safer method to treat functional constipation,and it has been experimentally used in clinical diagnosis and treatment.However,due to the limited number and the small sample size of related studies,there is no more objective accurate evidence and treatment standard for the efficacy and safety to FMT in the treatment of CFC.OBJECTIVES This Meta-analysis aims to systematically evaluate the efficacy and safety of FMT in the treatment of chronic constipation,so as to provide more objective evidence-based evidence for the further application of FMT in clinical practice.METHODS Searching terms were determined according to the principle of PICOS.The computer-based research was conducted on PubMed,EMBASE,CNKI,Wanfang,VP and Clinical trial.gov,collecting all domestic and foreign studies on the treatment of chronic constipation by FMT from the establishment of the database to February 2019.And,there was no restriction on the type of study design.The included literatures were selected by the established screening criteria,and its quality was evaluated.The characteristics of the subjects,experimental intervention measures,clinical outcome indicators and other relevant data in the literatures were extracted,and then the meta-analysis software OpenMetaAnalyst was used for correlation statistical analysis.According to the study design type and the difference between the control group,descriptive summary analysis was performed on the randomized controlled trials.Meta-analysis was performed on cohort studies,and 95%confidence interval(CI)was used to calculate the efficacy rate and(or)remission rate of FMT in the treatment of chronic constipation.Adverse events included in the studies were retrospectively analyzed.At the same time,according to the heterogeneity test results of the included cohort studies,subgroup analysis and sensitivity analysis were performed.RESULTS A total of 13 studies(10 non-controlled cohort studies and 3 randomized studies)included 729 patients with chronic constipation,624 of whom received FMT intervention.The proportions of recipients receiving clinical cure and remission were 45.83%(286/624)and 60.11%(324/539),respectively.The meta-analysis results of the cohort studies showed that the clinical cure rate and remission rate of patients with chronic constipation were 39.8%(95%CI 35.6-44.1%)and 55.8%(95%CI 47.4-63.9%),respectively.The subgroup analysis showed that the remission rate of patients receiving 3 times of FMT was 48.8%(95%CI 40.6-57.0%),and the remission rate of patients receiving at least 6 times of FMT was 57.7%(95%CI47.0-67.6%),with no statistical significance(P=0.189).The combined remission rate of upper gastrointestinal tract(fecal bacteria capsule,gastroscopy)was 45.7%(95%CI 31.9-60.1%),and that of middle gastrointestinal tract(nasointestinal tube)was 53.8%(95%CI 46.5-61.0%),with no statistically significant difference(P=0.309).The combined remission rate of long-term follow-up was 50.1%(95%CI 36.5-63.7%),and the combined remission rate of short-term follow-up was 57.4%(95%CI48.1-66.3%),showing a statistically significant difference(P=0.025).The combined remission rate of FMT alone was 52.0%(95%Cl 40.8-62.9%),and that of FMT combined with other drugs(probiotics,soluble dietary fiber)increased to 64.2%(95%CI 52.6-74.4%),but there was no statistical difference between the two groups(P=0.465).No serious adverse events occurred in all the studies,and most of the adverse events were mild and could disappear spontaneously during the follow-up.CONCLUSION FMT was safe and effective in the treatment of chronic constipation,and the short-term effect was obvious.However,there was no significant difference in the efficacy of FMT between upper and middle gastrointestinal delivery.The FMT process should be standardized,and the corresponding treatment guidelines should be developed to facilitate the smooth development of clinical work.More high-quality,large-sample,multi-center randomized controlled trials needed to be conducted for further verification before FMT used in the clinical treatment of chronic constipation widely. |
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