Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Apr 17;29(1):103.
doi: 10.1007/s10151-025-03113-7.

Fecal microbiota transplantation for patients with ulcerative colitis: a systematic review and meta-analysis of randomized control trials

R Gefen #  1   2 , J Dourado #  1 , S H Emile  1   3 , A Wignakumar  1 , P Rogers  1 , P Aeschbacher  1   4 , Z Garoufalia  1 , N Horesh  1   5 , S D Wexner  6
Affiliations
Meta-Analysis

Fecal microbiota transplantation for patients with ulcerative colitis: a systematic review and meta-analysis of randomized control trials

R Gefen et al. Tech Coloproctol. .

Abstract

Background: Fecal microbiota transplantation (FMT) has been shown to restore gut microbiome composition with an acceptable safety profile. FMT in inflammatory bowel disease, specifically ulcerative colitis (UC), has been investigated. We aimed to assess the efficacy of FMT in inducing UC remission.

Methods: PubMed, Scopus, Google Scholar, and clinicaltrials.gov were searched for randomized control trials that assessed FMT in inducing UC remission. The primary outcome was combined clinical and endoscopic remission. Secondary outcomes were clinical remission, endoscopic remission, post-treatment overall adverse events, and colitis. Sensitivity analyses, meta-regression, bias assessment, and grading of certainty of evidence were performed.

Results: A total of 14 studies including 600 patients (55.8% male; median age 40.7 years) were assessed. FMT was used in 299 patients and associated with significantly higher odds of combined clinical and endoscopic remission (OR 2.25, 95% CI 1.54, 3.3; p < 0.0001), clinical remission (OR 2.02, 95% CI 1.4, 2.93; p = 0.0002), and endoscopic remission (OR 1.95, 95% CI 1.17, 3.28; p = 0.011). The odds of post-treatment overall adverse events (OR 1.24, 95% CI 0.79, 1.95; p = 0.34) and colitis (OR 0.85, 95% CI 0.52, 1.93; p = 0.512) were similar between groups. Compared with baseline, FMT was more effective when biologics (OR 2.71), steroids (OR 2.27), or methotrexate (OR 3.07) were used as pre-FMT treatment. Oral delivery of FMT (OR 3.15) and pooled donors (OR 3.32) led to higher odds of remission. On meta-regression, pooled donors and methotrexate pre-treatment were associated with an increased likelihood of remission.

Conclusions: FMT is promising in inducing UC remission. Administration of medical treatments before FMT may help achieve higher remission rates. Current evidence shows that oral delivery of FMT and multidonor FMT may confer better results.

Keywords: Fecal microbiota transplantation; Meta-analysis; Randomized control trials; Ulcerative colitis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: Dr. Wexner is a consultant for ActivSurgical, Arthrex, Baxter, Becton, Dickinson and Co, Glaxo Smith Kline, Intuitive Surgical, OstomyCure, Takeda, and Virtual Ports; has consulting agreements with stock options for consulting with GI View, OstomyCure, and Virtual Ports; is a member of the Data Safety Monitoring Board of JSR/WCG/ACI (chair), Polypoid (chair) and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc., and Unique Surgical Solutions, LLC. Dr. Emile is a consultant for Becton, Dickinson and Co. Ethical approval and informed consent: Ethics approval and informed consent were not required for this type of study (literature review).

Figures

Fig. 1
Fig. 1
PRISMA Search Flowchart for Study Selection
Fig. 2
Fig. 2
Forest plot depicting the odds of remission (clinical, endoscopic, and combined remission) comparing FMT and control groups
Fig. 3
Fig. 3
Forest plot depicting the odds of adverse events and colitis comparing FMT and control groups
See this image and copyright information in PMC

References

    1. Nishida A, Inoue R, Inatomi O et al. (2018) Gut microbiota in the pathogenesis of inflammatory bowel disease. Clin J Gastroenterol 11:1–10. 10.1007/s12328-017-0813-5 - PubMed
    1. Shen ZH, Zhu CX, Quan YS et al. (2018) Relationship between intestinal microbiota and ulcerative colitis: mechanisms and clinical application of probiotics and fecal microbiota transplantation. World J Gastroenterol 24:5–14. 10.3748/wjg.v24.i1.5.PMID:29358877;PMCID:PMC5757125 - PMC - PubMed
    1. Fukushima S, Shiotani A, Matsumoto H et al. (2022) Comparison of mucosa-associated microbiota in Crohn’s disease patients with and without anti-tumor necrosis factor-α therapy. J Clin Biochem Nutr 270:182–188. 10.3164/jcbn.21-41 - PMC - PubMed
    1. Ooijevaar RE, Terveer EM, Verspaget HW, Kuijper EJ, Keller JJ (2019) Clinical application and potential of fecal microbiota transplantation. Annu Rev Med 70:335–351. 10.1146/annurev-med-111717-122956. (Epub 2018 Nov 7 PMID: 30403550) - PubMed
    1. Page MJ, McKenzie JE, Bossuyt PM et al. (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71 - PMC - PubMed