S1909 Fecal Microbiota Transplantation in IBD: A Meta-Analysis of Remission and Mucosal Healing Outcomes From Randomized Trials

Introduction: Inflammatory Bowel Disease (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD), remains a chronic relapsing condition with significant morbidity. While standard therapies target immune dysregulation, mounting evidence suggests a pivotal role for microbial dysbiosis. Fecal Microbiota Transplantation (FMT), a microbial restoration therapy, has shown promise in Clostridioides difficile infection but its therapeutic utility in IBD remains unclear due to inconsistent findings and heterogeneous endpoints. This study aimed to evaluate the efficacy of FMT in inducing clinical remission and mucosal healing in patients with UC and CD by synthesizing randomized controlled trial (RCT) data from 2020 to 2025. Methods: A systematic review and meta-analysis was conducted per PRISMA guidelines. Comprehensive searches were performed in PubMed, Cochrane, ClinicalTrials.gov, Google Scholar, and PLOS One using predefined Boolean strategies targeting FMT, IBD, remission, and mucosal healing. RCTs enrolling adult patients with UC or CD receiving FMT vs placebo or standard care were included. Primary endpoints were clinical remission and mucosal healing; secondary outcomes included adverse events and microbiome composition shifts. Data were pooled using random-effects models to generate risk ratios (RR) and 95% confidence intervals (CI). Results: Out of 537 screened studies, 7 high-quality RCTs (n = 542) met inclusion criteria. Clinical Remission: FMT significantly increased remission rates vs control (RR 1.74; 95% CI 1.29–2.34; P < 0.001; I² = 43%). Mucosal Healing: Observed in 38.2% of FMT recipients vs 24.6% of controls (RR 1.53; 95% CI 1.10–2.13; P = 0.01). Adverse Events: No significant increase in serious adverse events (RR 0.98; 95% CI 0.64–1.48). Subgroup analysis suggested higher efficacy in multi-donor FMT protocols and lower baseline microbial diversity. Conclusion: FMT improves both clinical and endoscopic outcomes in IBD, with acceptable safety. These findings support further investigation in biomarker-stratified populations and optimization of donor selection. Importantly, this study addresses the research gap between proof-of-concept studies and therapeutic standardization. FMT represents a viable adjunctive therapy for IBD algorithms., particularly UC, with demonstrable efficacy in remission induction and mucosal healing. Large-scale, multi-center trials with unified endpoints are now essential to refine its role in IBD treatment.