Samuel P. Costello MBBS Inflammatory Bowel Disease Service, Department of Gastroenterology, The Queen Elizabeth Hospital Australia

Ulcerative colitis: Fecal Microbiota Transplantation Can Induce Remission Interview with:

Samuel P. Costello MBBS Inflammatory Bowel Disease Service, Department of Gastroenterology, The Queen Elizabeth Hospital Australia

Dr. Costello

Samuel P. Costello MBBS
Inflammatory Bowel Disease Service,
Department of Gastroenterology
The Queen Elizabeth Hospital
Australia What is the background for this study?

Response: Ulcerative colitis (UC) is an inflammatory bowel disease that has high rates of persistent or relapsing symptoms despite available therapies. Many of these therapies also have the potential for unacceptable side effects including allergy, intolerance, serious infection and malignancy due to long-term immunosuppression. It is for these reasons that new therapies for Ulcerative colitis are required; particularly therapies that target novel pathways and are not immune suppressing. What are the main findings? 

Response: Two previous studies have shown a benefit of FMT over placebo for the induction of remission of UC. The most interesting finding of this study was that a short duration of low intensity of FMT could induce remission in ulcerative colitis at a similar rate to previous studies that use more intensive FMT treatment regimes. This study used one colonoscopy followed by 2 enemas in 1 week and then reassessed patients at week 8. We had a 23% gain of FMT over placebo which compares favourably with currently available therapies. Importantly, 95% of study participants found FMT delivered in this way to be an acceptable therapy. What should readers take away from your report?

 Response: FMT can induce remission in ulcerative colitis, however we do not yet have data on the efficacy of FMT as a maintenance agent or long term safety. As such further trials are required to determine if FMT can maintain remission in UC and also the long term safety of this therapy for UC. We are about to undertake such a study at the Queen Elizabeth Hospital in Adelaide. What recommendations do you have for future research as a result of this work?

Response: The long term aim of this research is to develop rationally designed microbial therapeutic that can replace Fecal Microbiota Transplantation. These will have bacteria that can carry out the therapeutic effect without the need to take whole faeces. This is obviously a better and less smelly option! Fecal Microbiota Transplantation studies are useful to be able to identify candidate organisms that could then be harnessed for such a therapy. At present Fecal Microbiota Transplantation for ulcerative colitis should be given in the clinical trial setting so that we can determine if it is a viable long term (maintenance therapy). 


Costello SP, Hughes PA, Waters O, et al. Effect of Fecal Microbiota Transplantation on 8-Week Remission in Patients With Ulcerative ColitisA Randomized Clinical TrialJAMA. 2019;321(2):156–164. doi:10.1001/jama.2018.20046

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Last Updated on January 16, 2019 by Marie Benz MD FAAD