Mythili Menon Pathiyil, MD, Arvind Kumar Venkataramana Raju, MD, George Abraham, MD, MPH Saint Vincent Hospital, Worcester, MA
Introduction: Ileal pouch-anal anastomosis is a procedure done after a pan proctocolectomy for various reasons like medically resistant ulcerative colitis, multiple synchronous cancers involving the rectum as well as adenomatous polyposis. While it helps retain anal function, there is a cumulative index rate of 45% of chronic pouchitis (CP) after 5 years of the procedure, which ranges from antibiotic responsive to antibiotic refractory with no effective treatment. While the etiology remains unclear, it is hypothesized that pouch microbiota has a role in the pathogenesis of CP. This study is aimed to evaluate the efficacy of FMT in patients with CP.
Methods: We searched Pubmed, EMBASE, and Google Scholar for randomized controlled trials and cohort studies evaluating FMT in the management of chronic pouchitis. The pooled estimates of relative risks from RCTs and response rates from cohort studies were estimated using a random effects model performed in CMA software. Confidence intervals for relative risks from individual RCTs were calculated, assuming the sampling distributions of the log-relative risk are normally distributed.
Results: Two randomized controlled trials and 7 observational cohort studies and case series with a total of 102 patients were included. The pooled rates of overall response were 45% (95% CI 34.9%-56%), clinical remission was 29% (95% CI, 8%–49%; I2= 30%), and overall remission rates were 24% (95% CI, 9%–43%; I2=29%), over a mean follow up of 5.2 months. There were no reported serious adverse effects or death.
Discussion: The evidence of the efficacy of FMT in chronic pouchitis remains lacking, but multiple cohort studies show variable efficacy with safe tolerability. However, data from prospective trials continue to be sparse, and more trials are required to make official recommendations.
Figure: This forest plot illustrates the event rates and 95% confidence intervals (CI) with pooled estimates for various studies examining the efficacy of fecal microbiota transplantation (FMT) in patients with chronic pouchitis.
Disclosures:
Mythili Menon Pathiyil indicated no relevant financial relationships.
Arvind Kumar Venkataramana Raju indicated no relevant financial relationships.
George Abraham indicated no relevant financial relationships.
Mythili Menon Pathiyil, MD, Arvind Kumar Venkataramana Raju, MD, George Abraham, MD, MPH. P0952 - Efficacy of Fecal Microbiota Transplantation in Chronic Pouchitis - A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
