Fecal microbiota transplantation and ulcerative colitis remission: A meta analysis

Introduction: Fecal microbiota transplantation's role in ulcerative colitis was discussed controversially. Literature regarding the route of administration lack. Aims: we aimed to assess the different routes of fecal microbiota transplantation in ulcerative colitis remission. Methods: A systematic literature search was conducted in PubMed Cochrane Library and Google Scholar from January 2011 up to September 2021. Two reviewers searched the databases for relevant articles. The terms microbiota transplantation, fecal transplantation, ulcerative colitis, inflammatory bowel disease, colonoscopy route, upper gastrointestinal route and oral capsule were used. The author's name year and country of publication, the study methodology and the results of the included studies were entered in Excel before data analysis by the most RevMan system. Results: Out of 762 studies retrieved, 25 full texts were screened and ten cohorts from 7 studies were included in the final meta-analysis. The colonic route (five cohorts), odd ratio, 4.06, 95% CI, 2.19-7.50, observed a higher rate of ulcerative colitis remission compared to placebo. The chi- square was 1.94 and the P-value for overall effect was < 0.0001. However, five cohorts including 35 events and 60 patients showed that fecal transplantation administered by the upper gastrointestinal tract was not different from placebo regarding clinical remission, odd ratio, 1.45, 95% CI, 0.48-4.37, P-value for overall effect, 0.51 and endoscopic remission, P-value, 0.91. Conclusion: Fecal microbiota transplantation administered by colonoscopy was effective in ulcerative colitis remission. However, upper gastrointestinal administration was not. Further, longer multicenter studies assessing the characters of donors, frequency and duration of microbiota administration are needed.