Gut Microbes. 2020 Nov 9;12(1):1-25. doi: 10.1080/19490976.2020.1854640.

Jessica Emily Green ^1 2 3, Jessica A Davis ¹, Michael Berk ^{1 4 5 6 7}, Christopher Hair ⁷, Amy Loughman ¹, David Castle ^4 8, Eugene Athan ^1 7 9, Andrew A Nierenberg ^10 11, John F Cryan ¹², Felice Jacka ^{1 13 14 15}, Wolfgang Marx ¹

Author information

• ¹IMPACT, the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Barwon Health, Deakin University , Geelong, Australia.
• ²Monash Alfred Psychiatry Research Centre (Maprc), Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University , Melbourne, Australia.
• ³Department of Psychiatry, Peninsula Health , Frankston, Australia.
• ⁴Department of Psychiatry, University of Melbourne , Parkville, Australia.
• ⁵Orygen Youth Health Research Centre and the Centre of Youth Mental Health , Melbourne, Australia.
• ⁶The Florey Institute for Neuroscience and Mental Health , Parkville, Australia.
• ⁷Barwon Health , Geelong, Australia.
• ⁸Department of Psychiatry, St Vincent's Health , East Melbourne, Australia.
• ⁹School of Medicine, Deakin University , Geelong, Australia.
• ¹⁰Department of Psychiatry, Dauten Family Center for Bipolar Treatment Innovation , Boston, MA, USA.
• ¹¹Harvard Medical School , Boston, MA, USA.
• ¹²Department of Anatomy and Neuroscience, University College Cork and APC Microbiome , Ireland.
• ¹³Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital , Parkville, Australia.
• ¹⁴Black Dog Institute , Melbourne, Australia.
• ¹⁵James Cook University , Townsville, Australia.

Abstract

The intestinal microbiome has been identified as a key modifier for a variety of health conditions. Fecal Microbiota Transplantation (FMT) has emerged as a fast, safe, and effective means by which to modify the intestinal microbiome and potentially treat a variety of health conditions. Despite extensive research of FMT for CDI, there is a lack of clarity informed by systematic synthesis of data regarding the safety and efficacy of FMT for other health conditions. This systematic review used PRISMA guidelines and was prospectively registered with PROSPERO (CRD42018104243). In March 2020, a search of MEDLINE, EMBASE, and PsycINFO was conducted. We identified 26 eligible studies. A meta-analysis of FMT for active Ulcerative Colitis (UC) showed that FMT significantly improved rates of clinical remission (OR = 3.634, 95% CI = 1.940 to 6.808, I² = 0%, p < .001), clinical response (OR = 2.634, 95% CI = 1.441 to 4.815, I² = 33%, p = .002) and endoscopic remission (OR = 4.431, 95% CI = 1.901 to 10.324, I² = 0%, p = .001). With respect to Irritable Bowel Syndrome, a meta-analysis showed no significant change in symptoms following FMT (p = .739). Hepatic disorders, metabolic syndrome, and antibiotic-resistant organisms were conditions with emerging data on FMT. Serious adverse events (AE) were more often reported in control group participants (n = 43) compared with FMT group participants (n = 26). There were similar rates of mild to moderate AE in both groups. Preliminary data suggest that FMT is a potentially safe, well-tolerated and efficacious treatment for certain conditions other than CDI, with evidence for active UC being the most compelling.