Meta-analysis Of The Efficacy And Safety Of Fecal Microbiota Transplantation(FMT) In The Treatment Of Ulcerative Colitis

Background and purpose:Ulcerative Colitis(UC)is an autoimmune disease whose pathogenesis is not completely clear and is closely related to human genetics,diet,environment,intestinal microecology and other factors.It is one of the main forms of Inflammatory bowel disease(IBD).In recent years,many studies have also shown that intestinal microecological disturbance plays an important role in the development of UC.Fecal microbiota transplantation(FMT)is a treatment technology that has emerged in recent years and has completely changed the field of microbial treatment.It is considered to have potential in some diseases related to intestinal microecological disturbance.And IBD is a research hotspot.All in all,n recent years,many related studies have demonstrated the effectiveness of FMT in the treatment of UC.Fecal microbiota transplantation is currently a potential treatment for ulcerative colitis,which may lessen the severity of ulcerative colitis.In order to evaluate its efficacy and safety and provide a basis for making implementation of FMT more effective,it is necessary to conduct further Meta-analysis.Materials and methods:We searched in major six databases,including PubMed,Cochrane Library,Embase,Medline,China Knowledge Network(CNKI),Wanfang Data Service Platform.The search period was from the establishment of the database to December 2019.The main outcome indicators included clinical remission,clinical response,and serious adverse events.The secondary outcome indicator was endoscopic remission for FMT treatment of UC.Literature screening and data extraction were performed independently by two researchers according to the inclusion and exclusion criteria,and R software was used for statistics and analysis.Results:Overall,a total of 37 studies(5 RCT studies and 32 cohort studies)met the inclusion criteria.In 5 randomized controlled trials,a total of 292 UC patients were included.Compared with the control group,FMT had a significant effect on UC,48.3%(71/147)(RR=1.79,95%CI:1.31?2.46,P<0.05)reached the outcome of clinical response,36.7%(54/147)achieved clinical remission(RR=2.14,95%CI:1.41?3.24,P<0.05),15.6%(23/14 7)achieved endoscopic remission(RR=3.00,95%CI:1.39?6.48,P=0.005).There was no statistically significant difference in serious adverse events between FMT group and control group(RR=1.41,95%CI:0.55?3.59,P=0.476).A total of 763 UC patients were included in this study in 32 cohort studies.The clinical response rate was 63%(95%CI:51%?74%).The clinical remission rate was 30%(95%CI:21%?41%).And the endoscopic remission rate was 40%(95%CI:19%?60%).No FMT-related SAEs were found in the cohort studies.The AEs occurred were mild,transient,and self-limited.The results of the subgroup analysis showed that the different routes of transplantation,whether the source of fecal bacteria was relatives,whether antibacterial drugs were used for pretreatment before FMT,and whether the type of feces was fresh or frozen had no significant effect on the efficacy of FMT for UC.Compared with single FMT,multiple FMT had a significant correlation with better efficacy.The clinical response rate of single FMT was 50%(95%CI:35%?65%).And the clinical response rate of multiple FMT was 75%(95%CI:60%?88%).There was statistically differences between the two groups in the clinical response rate(P=0.02).The clinical remission rate of single FMT was 20%(95%CI:9%?33%).And the clinical remission rate of the multiple FMT was 42%(95%Cl:28%?57%).The difference in clinical remission rate between the two groups was statistically significant(P=0.02).Conclusion:Based on the analysis of efficacy and safety,the use of FMT for has obvious efficacy and is relatively safe.It is expected to be used as a method for inducing remission of active UC.The difference in transplantation route,the source of fecal bacteria,whether to use antibacterial drugs,and the type of feces have no obvious effect on the efficacy.Multiple long-term treatment of FMT can improve its efficacy.However,the evaluation of the long-term safety and efficacy of FMT is still lack of further research,and needs more high-quality studies.Before considering the wide application of FMT in clinic,there are still many unresolved problems and details of the transplantation process that need further research and optimization.