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Systematic Review and Meta-analysis: Fecal Microbiota Transplantation for Treatment of Active Ulcerative Colitis

Narula, Neeraj MD, FRCPC*; Kassam, Zain MD, MPH; Yuan, Yuhong PhD*; Colombel, Jean-Frederic MD; Ponsioen, Cyriel MD, PhD§; Reinisch, Walter MD*; Moayyedi, Paul MBChB, PhD, MPH*

doi: 10.1097/MIB.0000000000001228
Clinical Review Articles

Background: Changes in the colonic microbiota may play a role in the pathogenesis of ulcerative colitis (UC) and restoration of healthy gut microbiota may ameliorate disease. A systematic review and meta-analysis was conducted to assess fecal microbiota transplantation (FMT) as a treatment for active UC.

Methods: A literature search was conducted to identify high-quality studies of FMT as a treatment for patients with UC. The primary outcome was combined clinical remission and endoscopic remission or response. Secondary outcomes included clinical remission, endoscopic remission, and serious adverse events. Odds ratios with 95% confidence intervals (CIs) are reported.

Results: Overall, 4 studies with 277 participants were eligible for inclusion. Among 4 randomized controlled trials, FMT was associated with higher combined clinical and endoscopic remission compared with placebo (risk ratio UC not in remission was 0.80; 95% CI: 0.71–0.89) with a number needed to treat of 5 (95% CI: 4–10). There was no statistically significant increase in serious adverse events with FMT compared with controls (risk ratio adverse event was 1.4; 95% CI: 0.55–3.58).

Conclusions: Among randomized controlled trials, short-term use of FMT shows promise as a treatment to induce remission in active UC based on the efficacy and safety observed. However, there remain many unanswered questions that require further research before FMT can be considered for use in clinical practice.

Supplemental Digital Content is Available in the Text.Article first published online 5 September 2017.

*Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada;

OpenBiome, Somerville, Massachusetts;

Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; and

§Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.

Address correspondence to: Neeraj Narula, MD, FRCPC, 1280 Main Street West, Unit 3V28, Hamilton, ON L8S 4K1, Canada (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

W. Reinisch and P. Moayyedi have joint senior authorship.

Author disclosures are available in the Acknowledgments.

Received May 03, 2017

Accepted June 08, 2017

© Crohn's & Colitis Foundation
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