Although more controlled trials are needed, fecal microbiota transplantation therapy shows promise in both adults and children with gastrointestinal diseases such as Clostridium difficile and inflammatory bowel disease, a systematic review showed.
A total of 844 patients from 10 countries who had undergone fecal microbiota transplantation were identified from 67 published studies. The most common indications were refractory/relapsing C. difficile infection (76.3%) and inflammatory bowel disease (13.2%). Results appeared online March 18 in Alimentary Pharmacology & Therapeutics.
The success rate was close to 91% for C. difficile infections among all trials. There was 1 placebo-controlled trial, a successful trial in 43 patients with recurrent C. difficile infections, in which duodenal infusion of healthy donor feces cured 15 of 16 recurrent patients.
The overall success rate of irritable bowel disease, including ulcerative colitis and Crohn’s disease, in adults is 77.8%. Fecal transplantation may improve ulcerative colitis, with a success rate close to 90%, as measured by disappearance of symptoms or reduction in ulcerative colitis activity index. Fecal transplantation was not effective in remission of Crohn’s disease.
The only reported serious adverse event attributed to the therapy was a case of suspected peritonitis.
Fecal transplantation could also be effective in treatment of some nongastrointestinal disorders such as metabolic syndrome or chronic fatigue syndrome, the authors wrote. It should be recognized as a form of organ transplantation, albeit a low-tech one.
“With the development of convenient equipment for fecal preparation and oral administrable capsules filled with fecal suspension or freeze-dried preparations, more patients may benefit from a standardized FMT (fecal microbiota transplantation) therapy with less aesthetic concerns, greater convenience and perhaps higher efficacy,” the authors wrote.