Clinical Scorecard: Changes in Gut Microbiota Following Fecal Microbiota Transplantation in Ulcerative Colitis: Association with Prevotellaceae Control

At a Glance

Key Highlights

• FMT treatment success in UC is associated with control of Prevotellaceae and enrichment of Ruminococcaceae and Lachnospiraceae families.
• Patients achieving remission showed lower Simpson dominance indicating higher microbial diversity compared to non-responders.
• Early microbiota composition differences can predict clinical response to FMT, enabling potential early treatment monitoring.

Guideline-Based Recommendations

Diagnosis

• Confirm UC diagnosis with clinical and endoscopic assessment using full Mayo score.
• Exclude patients with proctitis, recent antibiotic use, surgery, or recent other treatments.

Management

• Consider FMT as an experimental treatment option for mild to moderate UC patients.
• Pretreatment with budesonide for 3 weeks prior to FMT showed no significant effect on clinical response.
• Select donors carefully as donor-dependent effects influence microbiota engraftment.

Monitoring & Follow-up

• Collect longitudinal stool samples pre-, during, and post-FMT to assess microbiota composition.
• Monitor microbial family abundance, especially Prevotellaceae, Ruminococcaceae, and Lachnospiraceae, to predict treatment response.
• Assess clinical and endoscopic response at 14 weeks post-FMT initiation using full Mayo score.

Risks

• Early withdrawal due to worsening UC symptoms should be classified as non-response.
• Limited anti-inflammatory effect of short-term budesonide pretreatment may not improve FMT outcomes.

Patient & Prescribing Data

24 adult patients with mild to moderate ulcerative colitis randomized to budesonide or placebo pretreatment before FMT

38% of patients achieved remission at 14 weeks; responders had distinct gut microbiota profiles with lower Prevotellaceae dominance and higher diversity.

Clinical Best Practices

• Use full Mayo score including endoscopic subscore to evaluate clinical response.
• Consider longitudinal microbiota profiling to guide and predict FMT treatment success.
• Recognize that donor microbiota characteristics significantly impact engraftment and clinical outcomes.
• Classify early worsening symptoms as treatment failure to inform clinical decisions.

References

• Netherlands Trial Register NL9858