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Escherichia coli Nissle 1917 in Ulcerative Colitis Treatment: Systematic Review and Meta-analysis
Giuseppe Losurdo, Andrea Iannone, Antonella Contaldo, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi

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Giuseppe Losurdo, Andrea Iannone, Antonella Contaldo, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi

Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico, University of Bari. Italy

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.244.ecn

ABSTRACT
Background & Aims: Escherichia coli Nissle 1917 (EcN) has been recommended as a therapeutic tool for ulcerative colitis (UC) treatment. However, to date, no meta-analysis has been performed on this topic.

Methods: We performed a literature search on PubMed, MEDLINE, Science Direct and EMBASE. We evaluated success rates for induction of remission, relapse rates and side effects, expressed as Intention-To-Treat. Odd ratios (OR), pooled OR and 95% confidence intervals (CI) were calculated, based on the Mantel-Haenszel method. Heterogeneity was assessed by using the χ2 and I2 statistics and, if present, a random-effects model was adopted.

Results: We selected six eligible trials, with 719 patients, 390 assigned to the study group and 329 to the control group. EcN induced remission in 61.6% of cases, while in the control group (mesalazine) the remission was achieved in 69.5% of cases, with a mean difference of 7.9%. The pooled OR was 0.92 (95% CI 0.15-9.66, p=0.93). A single study showed a better performance of EcN than the placebo. A relapse of the disease occurred in 36.8% in the EcN group and in 36.1% in the control group (mesalazine), with a mean difference of 0.8%, OR=1.07, with a 95% CI of 0.70-1.64 (p=0.74). Side effects were comparable (OR=1.44, 95% CI 0.80-2.59, p=0.22).

Conclusions: EcN is equivalent to mesalazine in preventing disease relapse, thus confirming current guideline recommendations. EcN seems to be as effective as controls in inducing remission and therefore, its use cannot be recommended as in one study the comparison was performed against placebo. Further studies may be helpful for this subject.

Key words: ulcerative colitis – inflammatory bowel disease – probiotics – Escherichia coli Nissle – microbiota.

Abbreviations: EcN: Escherichia coli Nissle; UC: ulcerative colitis; IBD: inflammatory bowel disease; CD: Crohn’s disease; ITT: intention-to-treat.