title: Escherichia coli Nissle 1917 in Ulcerative Colitis Treatment: Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  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.
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico, University of Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Losurdo
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico, University of Bari, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Iannone
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico, University of Bari, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Contaldo
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico, University of Bari, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Ierardi
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico, University of Bari, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Di Leo
authors.affiliation: Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Consorziale Policlinico, University of Bari, Italy. b.principi@gmail.com.
authors.forename: Mariabeatrice
authors.initials: M
authors.lastname: Principi
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D003106:Colon / Q000382:microbiology* / Q000473:pathology; D004926:Escherichia coli / Q000145:classification / Q000254:growth & development*; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D000069196:Gastrointestinal Microbiome; D006801:Humans; D019804:Mesalamine / Q000627:therapeutic use; D016017:Odds Ratio; D019936:Probiotics / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005765:Gastrointestinal Agents; D019804:Mesalamine