The risk of inflammatory bowel disease flares after fecal microbiota transplantation

Systematic review and meta-analysis

Taha Qazi, Thelina Amaratunga, Edward L. Barnes, Monika Fischer, Zain Kassam, Jessica R. Allegretti

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Several studies have suggested worsening in inflammatory bowel disease (IBD) activity following fecal microbiota transplantation (FMT). We aimed to assess the risk of worsening in IBD activity following FMT. An electronic search was conducted using MEDLINE (1946-June 2016), EMBASE (1954-June 2016) and Cochrane Central Register of Controlled Trials (2016). Studies in which FMT was provided to IBD patients for IBD management or (Clostridium difficile infection) CDI treatment were included. The primary outcome was the rate of worsening in IBD activity. Results: Twenty-nine studies with 514 FMT-treated IBD patients were included. Range of follow up was 4 weeks to 3 y. The pooled rate of IBD worsening was 14.9% (95% CI 10–21%). Heterogeneity was detected: I2 D 52.1%, Cochran Q test D 58.1, p D 0.01. A priori subgroup analyses were performed. Although not significant, the pooled rate of worsening in IBD activity following FMT for CDI (22.7% (95% CI: 13–36%)) was higher compared with FMT for IBD (11.1% (95% CI 7–17%)). Rates of worsening in IBD after lower GI FMT delivery revealed a higher rate of worsening in IBD activity (16.5% (95% CI: 11–24%)) compared with upper GI delivery (5.6% (95% CI: 2–16%)). Rates of worsening in high quality studies and randomized controls trials (RCTS) suggested a marginal risk of worsening in IBD activity (4.6%, (95% CI: 1.8–11%). Rates of IBD worsening are overall marginal across high quality RCTS. It is unknown if the FMT itself led to the worsening of IBD in this small fraction or if this represents alternative etiologies.

Original languageEnglish (US)
Pages (from-to)1-15
Number of pages15
JournalGut Microbes
DOIs
StateAccepted/In press - Sep 11 2017

Fingerprint

Inflammatory Bowel Diseases
Meta-Analysis
Fecal Microbiota Transplantation
Clostridium Infections
Clostridium difficile
Disease Management
MEDLINE
Quality Control

Keywords

  • C. difficile
  • Crohn's Disease
  • fecal microbiota transplant
  • inflammatory bowel disease
  • ulcerative colitis

ASJC Scopus subject areas

  • Microbiology
  • Gastroenterology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

The risk of inflammatory bowel disease flares after fecal microbiota transplantation : Systematic review and meta-analysis. / Qazi, Taha; Amaratunga, Thelina; Barnes, Edward L.; Fischer, Monika; Kassam, Zain; Allegretti, Jessica R.

In: Gut Microbes, 11.09.2017, p. 1-15.

Research output: Contribution to journalArticle

Qazi, Taha ; Amaratunga, Thelina ; Barnes, Edward L. ; Fischer, Monika ; Kassam, Zain ; Allegretti, Jessica R. / The risk of inflammatory bowel disease flares after fecal microbiota transplantation : Systematic review and meta-analysis. In: Gut Microbes. 2017 ; pp. 1-15.
@article{48e7099896094a0886c7b83976feaf14,
title = "The risk of inflammatory bowel disease flares after fecal microbiota transplantation: Systematic review and meta-analysis",
abstract = "Several studies have suggested worsening in inflammatory bowel disease (IBD) activity following fecal microbiota transplantation (FMT). We aimed to assess the risk of worsening in IBD activity following FMT. An electronic search was conducted using MEDLINE (1946-June 2016), EMBASE (1954-June 2016) and Cochrane Central Register of Controlled Trials (2016). Studies in which FMT was provided to IBD patients for IBD management or (Clostridium difficile infection) CDI treatment were included. The primary outcome was the rate of worsening in IBD activity. Results: Twenty-nine studies with 514 FMT-treated IBD patients were included. Range of follow up was 4 weeks to 3 y. The pooled rate of IBD worsening was 14.9{\%} (95{\%} CI 10–21{\%}). Heterogeneity was detected: I2 D 52.1{\%}, Cochran Q test D 58.1, p D 0.01. A priori subgroup analyses were performed. Although not significant, the pooled rate of worsening in IBD activity following FMT for CDI (22.7{\%} (95{\%} CI: 13–36{\%})) was higher compared with FMT for IBD (11.1{\%} (95{\%} CI 7–17{\%})). Rates of worsening in IBD after lower GI FMT delivery revealed a higher rate of worsening in IBD activity (16.5{\%} (95{\%} CI: 11–24{\%})) compared with upper GI delivery (5.6{\%} (95{\%} CI: 2–16{\%})). Rates of worsening in high quality studies and randomized controls trials (RCTS) suggested a marginal risk of worsening in IBD activity (4.6{\%}, (95{\%} CI: 1.8–11{\%}). Rates of IBD worsening are overall marginal across high quality RCTS. It is unknown if the FMT itself led to the worsening of IBD in this small fraction or if this represents alternative etiologies.",
keywords = "C. difficile, Crohn's Disease, fecal microbiota transplant, inflammatory bowel disease, ulcerative colitis",
author = "Taha Qazi and Thelina Amaratunga and Barnes, {Edward L.} and Monika Fischer and Zain Kassam and Allegretti, {Jessica R.}",
year = "2017",
month = "9",
day = "11",
doi = "10.1080/19490976.2017.1353848",
language = "English (US)",
pages = "1--15",
journal = "Gut Microbes",
issn = "1949-0976",
publisher = "Landes Bioscience",

}

TY - JOUR

T1 - The risk of inflammatory bowel disease flares after fecal microbiota transplantation

T2 - Systematic review and meta-analysis

AU - Qazi, Taha

AU - Amaratunga, Thelina

AU - Barnes, Edward L.

AU - Fischer, Monika

AU - Kassam, Zain

AU - Allegretti, Jessica R.

PY - 2017/9/11

Y1 - 2017/9/11

N2 - Several studies have suggested worsening in inflammatory bowel disease (IBD) activity following fecal microbiota transplantation (FMT). We aimed to assess the risk of worsening in IBD activity following FMT. An electronic search was conducted using MEDLINE (1946-June 2016), EMBASE (1954-June 2016) and Cochrane Central Register of Controlled Trials (2016). Studies in which FMT was provided to IBD patients for IBD management or (Clostridium difficile infection) CDI treatment were included. The primary outcome was the rate of worsening in IBD activity. Results: Twenty-nine studies with 514 FMT-treated IBD patients were included. Range of follow up was 4 weeks to 3 y. The pooled rate of IBD worsening was 14.9% (95% CI 10–21%). Heterogeneity was detected: I2 D 52.1%, Cochran Q test D 58.1, p D 0.01. A priori subgroup analyses were performed. Although not significant, the pooled rate of worsening in IBD activity following FMT for CDI (22.7% (95% CI: 13–36%)) was higher compared with FMT for IBD (11.1% (95% CI 7–17%)). Rates of worsening in IBD after lower GI FMT delivery revealed a higher rate of worsening in IBD activity (16.5% (95% CI: 11–24%)) compared with upper GI delivery (5.6% (95% CI: 2–16%)). Rates of worsening in high quality studies and randomized controls trials (RCTS) suggested a marginal risk of worsening in IBD activity (4.6%, (95% CI: 1.8–11%). Rates of IBD worsening are overall marginal across high quality RCTS. It is unknown if the FMT itself led to the worsening of IBD in this small fraction or if this represents alternative etiologies.

AB - Several studies have suggested worsening in inflammatory bowel disease (IBD) activity following fecal microbiota transplantation (FMT). We aimed to assess the risk of worsening in IBD activity following FMT. An electronic search was conducted using MEDLINE (1946-June 2016), EMBASE (1954-June 2016) and Cochrane Central Register of Controlled Trials (2016). Studies in which FMT was provided to IBD patients for IBD management or (Clostridium difficile infection) CDI treatment were included. The primary outcome was the rate of worsening in IBD activity. Results: Twenty-nine studies with 514 FMT-treated IBD patients were included. Range of follow up was 4 weeks to 3 y. The pooled rate of IBD worsening was 14.9% (95% CI 10–21%). Heterogeneity was detected: I2 D 52.1%, Cochran Q test D 58.1, p D 0.01. A priori subgroup analyses were performed. Although not significant, the pooled rate of worsening in IBD activity following FMT for CDI (22.7% (95% CI: 13–36%)) was higher compared with FMT for IBD (11.1% (95% CI 7–17%)). Rates of worsening in IBD after lower GI FMT delivery revealed a higher rate of worsening in IBD activity (16.5% (95% CI: 11–24%)) compared with upper GI delivery (5.6% (95% CI: 2–16%)). Rates of worsening in high quality studies and randomized controls trials (RCTS) suggested a marginal risk of worsening in IBD activity (4.6%, (95% CI: 1.8–11%). Rates of IBD worsening are overall marginal across high quality RCTS. It is unknown if the FMT itself led to the worsening of IBD in this small fraction or if this represents alternative etiologies.

KW - C. difficile

KW - Crohn's Disease

KW - fecal microbiota transplant

KW - inflammatory bowel disease

KW - ulcerative colitis

UR - http://www.scopus.com/inward/record.url?scp=85029459903&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029459903&partnerID=8YFLogxK

U2 - 10.1080/19490976.2017.1353848

DO - 10.1080/19490976.2017.1353848

M3 - Article

SP - 1

EP - 15

JO - Gut Microbes

JF - Gut Microbes

SN - 1949-0976

ER -