Faecal transplantation increases remission in ulcerative colitis

2nd May 2023

A Cochrane review found that faecal transplantation improves clinical and possibly endoscopic remission in ulcerative colitis

Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) that presents with inflammation of the colonic mucosa. Estimates suggest that in 2017 there were 6·8 million global cases of IBS. To date, conventional IBD medical therapies currently only target the inflammatory component of the condition. However, evidence suggests microorganisms within the intestine have pro-inflammatory or anti-inflammatory activities which may modulate IBD. The concept of ‘dysbiosis‘, i.e., an alteration of the commensal microbial organisms relative to those in healthy individuals, may play a role in IBD. Faecal transplantation (FT) may play a role to correct dysbiosis in UC. In fact, there is evidence that the strategy is effective for Clostridium difficile infection.

Whether faecal transplantation is effective for ulcerative colitis was the subject of a recent Cochrane review. The researchers looked for randomised controlled trials that studied adults and children with UC or Crohn’s disease (CD). Eligible studies made use of FT, which is the delivery of healthy donor stool containing gut microbiota to a recipient’s gastrointestinal tract to treat UC or CD. The review examined both clinical and endoscopic disease remission.

Faecal transplantation and ulcerative colitis

A total of 12 studies with 550 participants were included. Studies lasted for 6 to 12 weeks.

Findings suggest that faecal transplantation may increase rates of induction of clinical remission in UC compared to control (risk ratio, RR = 1.79, 95% CI 1.13 – 2.84). Similarly, FT may increase rates of induction of endoscopic remission in UC (RR = 1.45, 95% CI 0.64 – 3.29). However, since the confidence intervals are wide, there is low certainty evidence for this effect. Two additional studies gave very uncertain evidence that FT could maintain clinical remission.

Taken together, it appears that FT may increase the proportion of people with active UC who achieve clinical and endoscopic remission. But there was less evidence that FT was effective for maintenance of remission in people with the condition.