{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T22:08:42Z","timestamp":1791842922859,"version":"4.3.4"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therap Adv Gastroenterol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>\n                    Ulcerative colitis (UC) is a chronic inflammatory bowel disease strongly associated with intestinal dysbiosis, reduced microbial diversity, and disrupted microbial metabolite profiles. Fecal microbiota transplantation (FMT) aims to restore microbial homeostasis and has shown a signal of benefit for induction of remission in some trials, but results are heterogeneous and long-term maintenance efficacy remains uncertain. In this narrative review, we synthesize randomized controlled trials (RCTs), systematic reviews\/meta-analyses, and recent guideline and regulatory updates on FMT in UC, and integrate mechanistic insights from microbiome and metabolomics research. Across RCTs, intensive lower-gastrointestinal regimens using pooled, multidonor material, and\/or anaerobic processing have most consistently achieved modestly higher steroid-free clinical and endoscopic remission than placebo in mild-to-moderate UC (approximately 25%\u201332% vs 5%\u201310% in representative studies), whereas upper-gastrointestinal delivery or oral lyophilized formulations and highly restrictive donor selection have yielded mixed or negative results. Mechanistically, responders commonly demonstrate engraftment of short-chain fatty acid producing taxa and restoration of secondary bile acid pathways. Safety profiles in trials are generally comparable to placebo for common mild adverse events, but rare severe transmissions (e.g., multidrug-resistant\n                    <jats:italic toggle=\"yes\">Escherichia coli<\/jats:italic>\n                    and SARS-CoV-2) have driven stricter donor screening and have limited routine use outside regulated programs. Current guidelines recommend against FMT for UC outside clinical trials. Future work should prioritize standardized protocols, biomarker-guided personalization, combination strategies (diet\/priming), and development of defined microbial therapeutics to improve efficacy and safety.\n                  <\/jats:p>","DOI":"10.1177\/17562848261426284","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T16:37:33Z","timestamp":1773247053000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Fecal microbiota transplantation in ulcerative colitis: evidence, mechanisms, and practice considerations"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1427-5078","authenticated-orcid":false,"given":"Jinghong","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1662-9404","authenticated-orcid":false,"given":"Xiaojuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Ganzhou People\u2019s Hospital, Ganzhou, Jiangxi 314000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.04.001"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.03.045"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30182-4"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.20046"},{"issue":"4","key":"e_1_3_5_6_2","first-page":"697","article-title":"Clinical practice guideline on fecal microbiota-based therapies: 2024 update","volume":"166","author":"American Gastroenterological Association","year":"2024","unstructured":"American Gastroenterological Association. Clinical practice guideline on fecal microbiota-based therapies: 2024 update. Gastroenterology 2024; 166(4): 697\u2013714.","journal-title":"Gastroenterology"},{"issue":"6","key":"e_1_3_5_7_2","article-title":"Specific bacteria and metabolites associated with response to fecal microbiota transplantation in ulcerative colitis","volume":"156","author":"Paramsothy S","year":"2019","unstructured":"Paramsothy S, et al. Specific bacteria and metabolites associated with response to fecal microbiota transplantation in ulcerative colitis. Gastroenterology 2019; 156(6): S-123.","journal-title":"Gastroenterology"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chom.2020.01.021"},{"issue":"3","key":"e_1_3_5_9_2","first-page":"567","article-title":"Gut microbiome features in relation to fecal microbiota transplantation outcomes in ulcerative colitis: a multicenter study","volume":"22","author":"Chu ND","year":"2024","unstructured":"Chu ND, et al. Gut microbiome features in relation to fecal microbiota transplantation outcomes in ulcerative colitis: a multicenter study. Clin Gastroenterol Hepatol 2024; 22(3): 567\u2013576.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.773105"},{"issue":"12","key":"e_1_3_5_11_2","first-page":"1018","article-title":"LOTUS Investigation Group. Lyophilised oral faecal microbiota transplantation for ulcerative colitis (LOTUS): a randomised, double-blind, placebo-controlled trial","volume":"6","author":"Tan P","year":"2021","unstructured":"Tan P, et al.; LOTUS Investigation Group. Lyophilised oral faecal microbiota transplantation for ulcerative colitis (LOTUS): a randomised, double-blind, placebo-controlled trial. Lancet Gastroenterol Hepatol 2021; 6(12): 1018\u20131029.","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2024.05.017"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izac135"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-021-01856-9"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-41182-6"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2022-327811"},{"key":"e_1_3_5_17_2","unstructured":"US Food and Drug Administration. Safety alert regarding use of fecal microbiota for transplantation. Silver Spring MD: U.S. Food and Drug Administration 2019."},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1910437"},{"key":"e_1_3_5_19_2","unstructured":"US Food and Drug Administration. Additional precautions for fecal microbiota transplantation during the SARS-CoV-2 pandemic. Silver Spring MD: U.S. Food and Drug Administration 2020."},{"issue":"1","key":"e_1_3_5_20_2","first-page":"1","article-title":"Expert consensus on clinical application management of fecal microbiota transplantation (2022 edition)","volume":"42","author":"Chinese Society of Gastroenterology","year":"2022","unstructured":"Chinese Society of Gastroenterology. Expert consensus on clinical application management of fecal microbiota transplantation (2022 edition). Chin J Dig 2022; 42(1): 1\u201310.","journal-title":"Chin J Dig"},{"issue":"4","key":"e_1_3_5_21_2","first-page":"231","article-title":"Nanjing consensus on methodology of washed microbiota transplantation","volume":"8","author":"Zhang T","year":"2020","unstructured":"Zhang T, et al. Nanjing consensus on methodology of washed microbiota transplantation. Gastroenterol Rep (Oxf) 2020; 8(4): 231\u2013239.","journal-title":"Gastroenterol Rep (Oxf)"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2024.07.047"},{"key":"e_1_3_5_23_2","first-page":"103846","article-title":"Systematic review of donor and recipient predictive biomarkers of fecal microbiota transplantation response in inflammatory bowel disease","volume":"76","author":"Fouladi F","year":"2022","unstructured":"Fouladi F, et al. Systematic review of donor and recipient predictive biomarkers of fecal microbiota transplantation response in inflammatory bowel disease. EBioMedicine 2022; 76: 103846.","journal-title":"EBioMedicine"},{"issue":"9","key":"e_1_3_5_24_2","article-title":"Microbiota and gut inflammatory markers (zonulin and fecal calprotectin) exhibit age-dependent variation in patients with ulcerative colitis","volume":"15","author":"Merino JJ","year":"2025","unstructured":"Merino JJ, Bastande Rey N, Fern\u00e1ndez-Garc\u00eda R. Microbiota and gut inflammatory markers (zonulin and fecal calprotectin) exhibit age-dependent variation in patients with ulcerative colitis. Life (Basel) 2025; 15(9): 1412.","journal-title":"Life (Basel)"},{"key":"e_1_3_5_25_2","unstructured":"Seres Therapeutics Inc. SER-287 (ECO-RESET) phase IIb trial in ulcerative colitis misses primary endpoint. Cambridge MA: Seres Therapeutics Inc. 2021."},{"key":"e_1_3_5_26_2","unstructured":"Vedanta Biosciences Inc. VE202 phase II trial in ulcerative colitis: topline results. 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