Fecal Microbiota Transplantation (FMT) in the Management of Ulcerative Colitis: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs)

Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon with increasing global prevalence, particularly in newly industrialized countries. Fecal microbiota transplantation (FMT) has worked as an effective therapeutic strategy aimed at restoring immune homeostasis and gut microbial balance. However, a lack of standardized protocols and comprehensive safety data necessitates further evaluation. This meta-analysis aims to comprehensively analyze the efficacy of FMT in inducing clinical remission in UC, incorporating the latest randomized controlled trials (RCTs). A systematic review and meta-analysis of RCTs investigating FMT in UC were conducted. The primary outcomes were clinical and endoscopic remission, while adverse events (AEs) were assessed as secondary outcomes. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, and heterogeneity was analyzed using the I2 statistic and Cochran's Q test. Overall, FMT demonstrated a significant benefit in inducing clinical remission compared with placebo (RR 1.55; 95% CI 1.22-1.96; p = 0.0003). For endoscopic remission, FMT showed a significant overall effect (RR 1.68; 95% CI 1.15-2.46; p = 0.007). The incidence of AEs was comparable between the FMT and control groups (RR 0.88; 95% CI 0.77-1.00; p = 0.06). This meta-analysis gives strong confirmation for the efficacy of FMT in inducing both clinical and endoscopic remission in UC patients, with a favorable safety profile. Multi-donor FMT and oral capsule administration appear to be particularly promising. Future research should focus on standardizing protocols, elucidating mechanisms of action, and conducting larger, long-term trials to optimize FMT for UC.