Systematic Review and Meta-Analysis of Fecal Microbiota Transplantation in Ulcerative Colitis

Overview

This meta-analysis of randomized controlled trials evaluated the efficacy and safety of fecal microbiota transplantation (FMT) in patients with ulcerative colitis (UC). The findings suggest that FMT may improve combined clinical and endoscopic remission rates compared to placebo or standard treatment, with comparable safety profiles.

Background

Ulcerative colitis is an inflammatory bowel disease characterized by alterations in gut microbiota, including a reduction in anti-inflammatory butyrate-producing bacteria. FMT aims to restore healthy intestinal microbiota composition, potentially reducing inflammation and improving intestinal function. While FMT is established for recurrent Clostridioides difficile infection, its role in UC treatment remains uncertain. This systematic review and meta-analysis assessed randomized controlled trials comparing FMT with placebo or standard therapy in UC patients to clarify its efficacy and safety.

Data Highlights

The meta-analysis included randomized controlled trials assessing combined clinical and endoscopic remission, clinical remission alone, endoscopic remission alone, and safety outcomes such as post-treatment worsening colitis and total adverse events. Statistical analyses used odds ratios with 95% confidence intervals and assessed heterogeneity with I2 statistics. Sensitivity analyses and meta-regression were performed to explore confounding factors including disease duration, donor criteria, FMT delivery route, and concurrent therapies.

Key Findings

• FMT significantly increased combined clinical and endoscopic remission rates in UC patients compared to controls.
• Clinical remission and endoscopic remission alone were also improved with FMT treatment.
• Safety profiles were comparable between FMT and control groups, with no significant increase in post-treatment worsening colitis or total adverse events.
• Factors such as donor selection, number of FMT sessions, and mode of administration influenced treatment efficacy.
• Concurrent use of steroids, biologics, or other anti-inflammatory agents may affect FMT outcomes.

Clinical Implications

FMT represents a promising adjunctive therapy for inducing remission in ulcerative colitis, potentially improving patient outcomes without increasing adverse events. Clinicians should consider donor selection, treatment protocols, and concurrent medications when integrating FMT into UC management. Further standardized protocols and larger trials are needed to optimize FMT use in clinical practice.

Conclusion

This systematic review and meta-analysis support the efficacy and safety of fecal microbiota transplantation in improving remission rates in ulcerative colitis patients. Tailoring treatment parameters may enhance therapeutic benefits.

References

1. Rodrigo et al. 2025 -- Systematic Review and Meta-Analysis of Randomized Controlled Trials on Fecal Microbiota Transplantation for Ulcerative Colitis Patients