| Background: Ulcerative colitis(UC)is a chronic,recurrent disease of the intestine that is currently unclear in etiology and pathogenesis.At present,the treatment of ulcerative colitis is mainly drug therapy,including amino salicylic acid,hormone,immunosuppressant,etc.In view of the often unsatisfactory therapeutic effect of drugs and the frequent recurrent and drug side effects and other clinical problems,there is an urgent need to explore and discover new safe and effective treatment measures.Studies have shown that the imbalance of intestinal flora plays an important role in the occurrence and development of ulcerative colitis.Faecal microbiota transplantation refers to the transplantation of functional bacteria in the feces of healthy people into the gastrointestinal tract of the patient and reconstruction of intestinal flora,to achieve the treatment of intestinal and parenteral diseases.FMT as a novel treatment,it has been shown to have a definite therapeutic effect on the treatment of Clostridium difficile infection(CDI).However,the safety,efficacy and tolerability of FMT for UC are still controversial.Objective: To evaluate the efficacy and safety of fecal microbiota transplantation(FMT)for the treatment of inflammatory bowel disease.And to explore the procedure,long-term effectiveness and safety of fecal microbiota transplantation(FMT)in patients with ulcerative colitis(UC).Methods: Systematic research combined with clinical trials.This study mainly includes two aspects: ONE: Efficacy and safety of FMT for the treatment of IBD: a system review and meta-analysis.We searched Medline(from 1948),web of science(from 1926),Cochrane library(for all years),EMBASE(from 1947),CNKI,Wanfang Data,Pubmed.Included studies were cohort studies and RCT that investigated FMT as an induction of remission for IBD in both paediatric and adult patients.extracted information according to inclusion and exclusion criteria,and used the R soffware for Mela-analysis.The other: Five patients with active UC were treated with FMT through single colonoscopy.The adverse reactions,clinical manifestations and laboratory results colonoscopy and histologic were recorded before and after FMT respectively.Disease response was evaluated with Mayo scores.Results:Finally,26 articles of FMT for IBD were deemed to satisfy the study selection criteria including 22 cohort studies and 4 randomized controlled trial(RCT).A total of 575 case patients,and 438 patients received FMT therapy.Overall,29.2%(128/438)of IBD patients achieved clinical remission during follow-up.The cohort studies included 298 patients,the clinical remission rate was 30%(89/298)in IBD.In meta-analysis of the 4 RCTs,the clinical remission was achieved in 39 of 140(28%)patients in the FMT groups. The average disease duration of 5 patients with UC was range 0.5-25 years.Follow-up time ranged from 4 to 9 months.5 patients all received FMT therapy.All patients achieved some extent of improvements with the clinical symptoms and laboratory results.The Mayo scores decreased from 11,5,12,8 and 9 to 1,1,2,2,4 points at 4 weeks after FMT and the Mayo scores was 1,0,1,3 and 2 points at 8 weeks.4 of 5 patients achieved clinical remission and 1 patient achieved clinical responseat 4 weeks and 8 weeks,and 4 patients remained clinical remission after 24 weeks of follow-up.Some patients had slight abdominal pain,bloating and diarrhea after FMT treatment.All of which were self-limiting,lasting generally no more than 24 h.One patient had fever and disease worsening caused by Epstein-Barr virus infection,which were controlled by the symptomatic treatment and antibiotics.Severe adverse reactions were not found.Conclusion:Current evidence shows that fecal transplantation for the treatment of inflammatory bowel disease(UC)is effective and safe,patients are well tolerated,and long-term follow-up found that some patients can be maintained remission,FMT is expected to be the best treatment option for first-time or standard IBD failure. |
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