Assessing the efficacy and safety of fecal microbiota transplantation and probiotic VSL#3 for active ulcerative colitis: A systematic review and meta-analysis

Abstract

Background Fecal microbiota transplantation is an effective treatment for many gastrointestinal diseases, such as Clostridium difficile infection and inflammatory bowel disease, especially ulcerative colitis. Changes in colonic microflora may play an important role in the pathogenesis of ulcerative colitis, and improvements in the intestinal microflora may relieve the disease. Fecal bacterial transplants and oral probiotics are becoming important ways to relieve active ulcerative colitis. Purpose This systematic review with meta-analysis compared the efficacy and safety of basic treatment combined with fecal microbiota transplantation or mixed probiotics therapy in relieving mild to moderate ulcerative colitis. Methods The PubMed, Embase, and Cochrane libraries (updated September 2019) were searched to identify randomized, placebo-controlled, or head-to-head trials assessing fecal microbiota transplantation or probiotic VSL#3 as induction therapy in active ulcerative colitis. We analyze data using the R program to obtain evidence of direct comparison and to generate intermediate variables for indirect treatment comparisons. Results Seven randomized, double-blind, placebo-controlled trials were used as the sources of the induction data. All treatments were superior to placebo. In terms of clinical remission and clinical response to active ulcerative colitis, direct comparisons showed fecal microbiota transplantation (

Fecal microbiota transplantation in inflammatory bowel disease patients: A systematic review and meta-analysis

“…In addition, no statistical difference was observed between FMT and the probiotics in terms of clinical efficacy. Despite these promising results, the authors point to many unresolved issues regarding the clinical application of these alternatives, suggesting that more randomized controlled trials are needed [ 69 ].…”

The Role of Gut Microbiota Biomodulators on Mucosal Immunity and Intestinal Inflammation

“…The VSL#3 treatment determines anti-inflammatory effects in experimental colitis, as evidenced by reduced disease activity index (DAI) score, histological activity index (HAI) score and myeloperoxidase (MPO) activity [120]. Furthermore, in different randomized, double-blind, placebo-controlled trials the use of VSL#3 in UC patients showed significant effects in terms of clinical remission and clinical response during active UC with no side-effects [81,121]. However, the efficacy of probiotics in IBD remains uncertain, since different meta-analyses showed that there were no significant differences of remission, relapse, and complication rate between probiotics and placebo group, thus, more evidences from randomized clinical trials (RCTs) are required [122,123].…”

The Link between Oral and Gut Microbiota in Inflammatory Bowel Disease and a Synopsis of Potential Salivary Biomarkers

“…Treatments for IBD include several classes of drug therapy, i.e., immunosuppressants, corticosteroids, aminosalicylates, and, more recently, monoclonal antibodies, in addition to palliative treatments like antibiotics, analgesics, anticholinergics, and antidiarrheal agents [3,9,17]. Holistic treatments and therapies emphasizing the importance of diet as well as intentional microbial shifts through the use of probiotics and heterologous and autologous fecal microbiota transplantation (FMT) have also gained momentum in recent years [18][19][20], although currently FMT is only FDA-approved for use in qualified recurrent Clostridium difficile associated infection in patients. Proper treatment and diagnosis of IBD are important as they have the potential to significantly improve patients' daily lives as IBD can become a crippling disease.…”