Fecal Microbiota Transplantation and Health Outcomes: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials

Abstract

BackgroundMeta-analysis of randomized clinical trials (RCT) demonstrated several health benefits of fecal microbiota transplantation (FMT). However, there has been little comprehensive assessment of the strength and quality of evidence. We conducted an umbrella review to summarize the evidence of the association between FMT and health outcomes.MethodsPubMed, Embase, and Cochrane library databases were searched from inception to August 6, 2021. The random-effects model was applied to recalculate the effect estimates. We used AMSTAR 2 and GRADE to assess the methodological quality and to grade the evidence.ResultsA total of 7 meta-analyses comprising 26 RCTs (median [IQR] primary study, 6 [2-7]; median [IQR] sample size, 267 [147-431] participants) were included in the current umbrella review describing 45 unique associations. There were 22 statistically significant associations (49%) demonstrating beneficial outcomes of FMT for antibiotic resistance burden, functional constipation, inflammatory bowel disease, and C. difficile infection. FMT does not appear to be associated with positive outcomes in irritable bowel syndrome and metabolic syndrome. Eight significant associations (36%) were supported by moderate-quality evidence, nine associations (41%) were supported by low-quality evidence, and the remaining associations found to be significant were supported by very low-quality evidence.ConclusionAlthough we found that FMT was positively associated with several outcomes, caution should be exercised in choosing this approach, given the insufficient number of primary studies, low methodological quality, and low quality of evidence. Further high-quality randomized controlled trials with long-term follow-up are needed to improve the strength and credibility of the evidence base.

Unveiling the hidden world of gut health: Exploring cutting-edge research through visualizing randomized controlled trials on the gut microbiota

“…It has been extensively examined for recurrent Clostridium difficile infections[ 100 - 104 ]. FMT may assist patients with metabolic syndrome[ 105 , 106 ] and insulin resistance[ 107 ], especially when employing lean donors. This therapy increased gut microbiota diversity and insulin sensitivity.…”

New treatment approaches for Clostridioides difficile infections: alternatives to antibiotics and fecal microbiota transplantation

“… 18 Fecal microbiota transplantation (FMT) is a widely used treatment option for recurrent CDI in various populations, as described in recent reviews. 15 , 16 Despite its very good clinical results, FMT has logistical, safety, and acceptance-related drawbacks, and alternative options are being extensively investigated. 19 Complex microbiota-based live biotherapeutics, still based on fecal material, can be positioned in the intersection between FMT efficacy and probiotics safety and acceptability.…”

Progress in research on gut microbiota in ethnic minorities in China and consideration of intervention strategies based on ethnic medicine: A review

“…The underlying causes of numerous illnesses have been connected thanks to the ongoing advancements in gut microbiota research. The restoration of the gut’s unbalanced microbiota is also emerging as a potential alternate course of action ( Li et al., 2022 ). The bacteria that live in the human intestine are collectively referred to as the gut microbiota.…”

“…The use of stool therapy dates back to over 1700 years ago in traditional Chinese medicine ( Zhang et al., 2018 ). FMT was first described as an adjuvant treatment for patients with antibiotic-associated diarrhea by ( Eiseman et al., 1958 ), ushering in the contemporary age ( Li et al., 2022 ). The makeup of gut bacteria and the transformation of active metabolites are significant aspects of traditional Chinese medicine (TCM) ( Li et al., 2022 ).…”

“…FMT was first described as an adjuvant treatment for patients with antibiotic-associated diarrhea by ( Eiseman et al., 1958 ), ushering in the contemporary age ( Li et al., 2022 ). The makeup of gut bacteria and the transformation of active metabolites are significant aspects of traditional Chinese medicine (TCM) ( Li et al., 2022 ). From the standpoint of TCM, According to Chinese medicine, the human body, with its tissues and organs, as well as the surroundings, nature, and way of life, are one cohesive whole.…”