Review article: Faecal transplantation therapy for gastrointestinal disease.

Jonathan Landy (1, 2) , Hafid Omar (2) , Simon D Mclaughlin (3) , Alan W Walker (4) , Paul Ciclitira (5) , John Nicholls (6) , Sue K Clark (7) , Ailsa Hart (1, 2)

1 IBD Unit
2 APRG
3 Gastroenterology
4 The Wellcome Trust Sanger Institute [Cambridge]
5 Guy's and St Thomas' Hospital [London]
6 BSST - Department of Biosurgery and Surgical Technology
7 Surgery

Background: Evidence is emerging regarding the relationship between a dysbiosis of the human gut microbiota and a number of gastrointestinal diseases as well as diseases beyond the gut. Probiotics have been investigated in many gastrointestinal disease states, with variable and modest outcomes. Faecal transplantation is an alternative approach to manipulate the gut microbiota. Aims: To review the use of faecal transplantation therapy for the management of gastrointestinal disorders. Methods: Available articles on faecal transplantation in the management of gastrointestinal disorders, were identified through a Pubmed search and bibliographies of review articles on the subject were collated. Results: 239 patients who had undergone faecal transplantation were reported. Seventeen of twenty two studies of faecal transplantation were in fulminant or refractory Clostridium difficile. Studies of faecal transplantation are heterogeneous regarding the patients, donors, screening, methods of administration, and definition of response. Faecal transplantation for Clostridium difficile has been demonstrated to be effective in 145/166 (87%) patients. Small numbers of patients are reported to have undergone successful faecal transplantation for irritable bowel syndrome and inflammatory bowel disease. Conclusions: Faecal transplantation has been reported with good outcomes for fulminant and refractory Clostridium difficile. No adverse effects of faecal transplantation have been reported. However, there are no level 1 data of faecal transplantation and reports to date may suffer from reporting bias of positive outcomes and under-reporting of adverse effects. This therapy holds great promise where a dysbiosis of the gut microbiota is responsible for disease and further studies are necessary to explore this potential.

Mots clés: Medicine

Jonathan Landy, Hafid Omar, Simon D Mclaughlin, Alan W Walker, Paul Ciclitira, et al.. Review article: Faecal transplantation therapy for gastrointestinal disease.. Alimentary Pharmacology and Therapeutics, 2011, 34 (4), pp.409. ⟨10.1111/j.1365-2036.2011.04737.x⟩. ⟨hal-00653686⟩