If you have ulcerative colitis (UC), you may wish you could swap out your entire digestive system. There's a potential treatment that may come close: someone else's fecal matter.
Often called fecal microbiota transplants (FMT), this procedure involves specially prepared fecal samples from a healthy donor — one without UC or other digestive conditions — which is introduced into the large intestine (colon) of someone with an inflammatory disease like UC.
The idea is that the healthy bacteria from the donor will populate the recipient's gut, calming inflammation and helping the digestive tract heal.
"In concept, a fecal transplant can help restore gut microbiome balance, which would go a long way toward addressing UC because that condition is characterized by an imbalance between the intestinal immune system and the gut microbiome," says Jeremy Polman, DO, an inflammatory bowel disease fellow and gastroenterology researcher at Northwell Lenox Hill Hospital in New York City. "This is not yet approved as a front-line treatment option for UC, but it's progressing through clinical trials to the point that it might be more widely available in the future."
There are some instances where people with UC are receiving these treatments, however. Here's what to know about when it's used, and what may be on the horizon.
How Do Fecal Transplants Work?
Because the gut microbiome — which is a mix of bacteria, fungi, and viruses that live in your digestive system — plays a significant role in UC, finding better ways to support and nourish those beneficial gut bugs is crucial, says Seifeldin Hakim, MD, a gastroenterologist at Memorial Hermann in Houston.
Strategies for managing your microbiome can include stress reduction, probiotic-rich foods, and high-quality sleep, but FMT has the potential to be a major shortcut, he says
"The whole goal of fecal transplantation is restoring the balance between good bacteria and bad bacteria," he says. "We've seen in clinical trials and also in instances where FMT is done in patients with a recurrent Clostridioides difficile (C. diff) infection that it works quite well and also very quickly."
In terms of how the process works, it's fairly straightforward. A donor for FMT is identified based on a number of criteria, including being generally healthy, not having any chronic gastrointestinal disorders, and not having taken antibiotics within the past six months.
That donor provides a small sample of fecal matter which is collected and then purified so only the beneficial bacteria remains. In some cases, a sample will involve stool from multiple donors in order to get more strains of bacteria that can colonize a recipient's gut. Whether from one or more donors, the sample is mixed with saline and delivered to a recipient's digestive tract during a colonoscopy or upper endoscopy.
Newer, less intrusive methods of delivery are also available, says Dr. Polman. For example, a technique approved for the treatment of recurrent C. diff — which is currently the only condition that FMT is approved by the U.S. Food and Drug Administration (FDA) to treat — involves a device called Rebyota that delivers the sample through a type of enema (a liquid solution inserted into the anus). That means it can be done in a doctor's office, without the type of multiday bowel prep you'd need with a procedure like a colonoscopy.
There are also fecal transplant pills, which contain live bacteria that have been freeze-dried and can reactivate when they reach your colon. The FDA has approved one called VOWST, also for treating recurrent C. diff, which is taken over a course of three days.
If you have some healthy friends with bulletproof digestive systems, you might be tempted to do it yourself and try an at-home process. Don’t do that, says Polman.
"Trying to do this on your own can significantly increase your risk of developing a bacterial infection," he says. "Also, without proper donor screening, you may be introducing new, chronic diseases into your system." For example, research on DIY FMTs found that lack of donor screening may lead to viral hepatitis or human immunodeficiency virus (HIV) in the recipient.
Fecal Transplants for Ulcerative Colitis: What the Science Shows
Although FMT is not yet widely used to treat UC itself, you may be a candidate for the treatment if you've struggled with an infection like C. diff that keeps recurring. According to research, about 17 percent of people hospitalized with UC develop a C. diff infection.
FMT could be an option in those cases.
Studies done on UC specifically, without the presence of C. diff, show promising results, says Polman. For instance, one clinical trial of people with UC who received fecal transplants showed a higher likelihood of remission at eight weeks after the transplant compared to a control group. Of those getting the FMT, nearly half maintained remission after a year.
Another clinical trial using multi-donor samples and intensive dosing on those with UC found that 27 percent of patients getting FMT achieved remission, compared to only 8 percent of those receiving a placebo. Because of those results, the researchers called FMT a promising new option for UC.
Would a Fecal Transplant Help Your Ulcerative Colitis Symptoms?
Although FMT is considered a promising option after nearly a decade of clinical trials and testing, keep in mind that it's still not to the point where it might replace existing UC treatments like immunomodulators, says Polman.
"Overall, what we see with clinical trials is that remission rates are about 30 percent with fecal transplants, but that's still lower than what current therapies offer in terms of remission," he says. For instance, research notes that corticosteroids successfully lead to remission in up to 70 percent of people with UC.
"At some point, we may see fecal transplants as a complement to existing therapies as a way to manage UC more effectively," says Polman. "Even in that case, though, lifestyle changes and medication adherence will continue to be top focus for minimizing UC symptoms."
If you're struggling to get your UC symptoms under control even with different medications, you might want to consider asking your gastroenterologist about whether enrolling in a clinical trial for FMT could be right for you, says Dr. Hakim.
The Takeaway
Fecal microbiota transplants involve taking beneficial bacteria from a healthy donor's stool and inserting them into a recipient via a colonoscopy, enema, or pill.
These transplants are designed to populate an inflamed gut with bacteria that can help reduce inflammation and subsequently heal the digestive system.
Fecal microbiota transplants are only FDA-approved for treating recurrent C. diff infections right now, but they may be part of the UC treatment mix in the future after more research is done.
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Řehořová V et al. Multi-Donor Fecal Microbial Transplantation for Critically Ill Patients: Rationale and Standard Operating Procedure. Future Pharmacology. March 4, 2022.
Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.
Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.
She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.
Elizabeth Millard is a freelance writer based in northern Minnesota. She focuses on health, wellness, and fitness, and has written for Runner's World, Bicycling, Self, Women's Health, Men's Health, Prevention, Experience Life, and more. She is an American Council on Exercise–certified personal trainer and a Yoga Alliance-registered yoga teacher. She graduated from Harvard University with a bachelor's degree in English.
