Effectiveness and Safety of Fecal Microbiota Transplantation for Ulcerative Colitis Treatment: A Systematic Review and Meta-Analysis.

Abstract

Introduction: Despite advances in pharmaceuticals, managing ulcerative colitis (UC) remains challenging. Interest in fecal microbiota transplantation (FMT) for UC is growing, but varying formulations and endpoints in trials complicate safety and efficacy assessment. This systematic review and meta-analysis offer a validated, up-to-date overview of FMT's efficacy and safety in UC.

Methods: We searched four electronic databases and analyzed only randomized clinical trials that investigated the clinical and endoscopic efficacy of FMT in UC, regardless of administration route or dose. Clinical and endoscopic remission was assessed by comparing the odds ratio (OR) and 95% confidence interval.

Results: The initial search yielded 6,737 studies with 15 meeting inclusion criteria after duplicate removal and screening. The meta-analysis showed clinical remission in 62% receiving FMT vs. 50.5% in controls (OR 2.65; 1.76, 4.00). The endoscopic response was 42% in the FMT group vs. 22% in controls (OR 2.00; 1.09; 3.68). Heterogeneity was assessed as low (by I2 index and τ2).

Conclusion: Our data show that FMT significantly improves clinical and endoscopic remission rates, offering a promising nonpharmacological option for UC patients unresponsive to conventional treatments. Further prospective studies are needed to optimize the formulation, dosing, while also address the safety profile of FMT in UC.