Stool transplant most effective when delivered via lower gastrointestinal route
Foecal microbiota transplantation (FMT) done through the lower gastrointestinal (LGI) delivery route appears to be the most effective way for the prevention of recurrence/relapse of Clostridium difficile infection (CDI), suggests a study.
“FMT has been proven to be a safe and highly effective therapeutic option for CDI,” said researchers. “Delivery … could be via the UGI (upper gastrointestinal) or LGI routes, [but] it is unclear as to which route provides better clinical outcome.”
To determine which delivery route of FMT is the most effective for refractory or recurrent/relapsing CDI, researchers systematically searched for studies that reported the use of FMT for CDI treatment. They obtained individual patient data, including demographic (age and sex) and clinical (route of FMT delivery, CDI outcome after FMT and follow-up time) information.
To evaluate clinical failure after FMT by the delivery route, Kaplan-Meier cumulative hazard curves and Cox proportional hazard models were used.
Of the 305 participants analysed, 208 were treated with FMT via the LGI route and 97 via the UGI route.
The risk of clinical failure at 30 and 90 days was 5.6 and 17.9 percent in the UGI delivery route group compared with 4.8 and 8.5 percent in the LGI group, respectively. Based on a time-varying analysis, UGI delivery had a threefold increase in hazard of clinical failure (hazard ratio, 3.43; 95 percent CI, 1.32 to 8.93) in the period after 30 days.
Researchers suggested that a randomized controlled trial be conducted to determine whether FMT delivered via the LGI route is indeed better than that delivered via the UGI route.