FMT in Ulcerative Colitis: JGH | July 2026

Introduction:

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with a rising global burden. Although current therapies are effective, many patients fail treatment or experience adverse effects. Fecal microbiota transplantation (FMT) has emerged as a promising microbiome-based therapy aimed at restoring gut microbial balance and immune homeostasis.

Why was this article needed?

• Previous FMT studies showed encouraging but inconsistent results.
• Optimal donor selection, delivery route, and treatment protocols remain unclear.
• Long-term safety and durability of response require further evaluation.
• Recent randomized controlled trials warranted an updated meta-analysis.
• The study also assessed whether multi-donor FMT and oral capsule therapy improve outcomes.

Results:

• FMT significantly improved both clinical symptoms and endoscopic remission, confirming its superiority over placebo in active UC.
• FMT demonstrated a favorable short-term safety profile, with adverse events comparable to placebo.
• Multi-donor FMT and oral capsule delivery emerged as the most promising strategies, although standardized protocols and long-term data are still needed.

Clinical Impact:

This updated meta-analysis strengthens the evidence supporting FMT as an effective and safe option for inducing remission in UC. Although it remains investigational in routine practice, FMT is emerging as one of the most promising microbiome-based therapies for selected patients.

Bottom Line:

FMT is an effective microbiome-based therapy for inducing remission in ulcerative colitis. Multi-donor FMT and oral capsule delivery appear particularly promising, but larger long-term trials are needed before widespread clinical adoption.