Aim. Increasing evidence supports the role of the gut microbiota in the etiology of ulcerative colitis (UC). Fecal microbiota transplantation (FMT) is a highly effective treatment against recurrent Clostridium difficile infection; however, its efficacy in UC is still controversial. A systematic review and meta-analysis was conducted to evaluate the efficacy and safety of FMT for treatment of active UC. Methods. We searched Cochrane, Medline, Web of Science, and Embase from inception to February 2020. Randomized controlled trials (RCTs) recruiting adults with active UC, which compared FMT with controls, were eligible. The primary outcome was combined clinical remission with endoscopic remission/response. Secondary outcomes included clinical remission, endoscopic remission, and serious adverse events. Relative risk (RR) with 95% confidence interval (CI) is reported. Results. Five RCTs with 292 participants were eligible for inclusion. When data were pooled for all patients, FMT was associated with a higher combined clinical remission with endoscopic remission/response; the RR of combined outcome not achieving after FMT vs. control was 0.79 (95% CI 0.70-0.88). FMT delivered via lower gastrointestinal route was superior to upper gastrointestinal route with regard to combined clinical remission with endoscopic remission/response (, 95% CI 0.70-0.89). FMT with pooled donor stool (, 95% CI 0.56-0.85) and higher frequency of administration (, 95% CI 0.62-0.93) may be more effective with regard to clinical remission. There was no statistically significant difference in serious adverse events with FMT compared with controls (, 95% CI 0.93-1.03). Conclusion. FMT shows a promising perspective with comparable safety and favorable clinical efficacy for the treatment of active UC in the short term. However, further larger, more rigorously conducted RCTs of FMT in UC are still needed in order to resolve the controversial questions.

中文翻译：

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粪便微生物菌群移植作为治疗活动性溃疡性结肠炎的治疗方法：系统评价和荟萃分析

目的。越来越多的证据支持肠道菌群在溃疡性结肠炎（UC）病因学中的作用。粪便菌群移植（FMT）是一种针对复发性艰难梭菌感染的高效治疗方法。但是，其在UC中的疗效仍存在争议。进行了系统的审查和荟萃分析，以评估FMT治疗活动性UC的疗效和安全性。方法。从开始到2020年2月，我们对Cochrane，Medline，Web of Science和Embase进行了搜索。符合条件的研究招募了患有活动性UC的成年人（将FMT与对照进行比较）的随机对照试验（RCT）。主要结果是临床缓解与内镜缓解/缓解相结合。次要结果包括临床缓解，内窥镜缓解和严重不良事件。据报道，相对危险度（RR）具有95％的置信区间（CI）。结果。有292名参与者的5项RCT符合纳入条件。当汇总所有患者的数据时，FMT与较高的临床缓解率和内镜缓解率/反应率相关。FMT与对照相比未达到合并结果的RR为0.79（95％CI 0.70-0.88）。就临床缓解与内镜缓解/反应相结合而言，通过下消化道途径进行的FMT优于上消化道途径（， 95％CI 0.70-0.89）。带供体粪便的FMT（， 95％CI 0.56-0.85）和更高的给药频率（， 95％CI 0.62-0.93）在临床缓解方面可能更有效。与对照组相比，FMT的严重不良事件没有统计学上的显着差异（， 95％CI 0.93-1.03）。结论。FMT在短期内显示出可观的前景，具有可比的安全性和良好的临床疗效，可用于治疗活动性UC。但是，为了解决有争议的问题，仍需要在UC中使用更大，更严格的FMT RCT。