J Gastroenterol Hepatol. 2022 Feb;37(2):246-255. doi: 10.1111/jgh.15731.Epub 2021 Nov 12.

Karen M J Waller ^1 2, Rupert W Leong ^1 2 3, Sudarshan Paramsothy ^1 2 3

Author information

¹Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.

²Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

³Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.

Abstract

Our understanding of the microbiome and its implications for human health and disease continues to develop. Fecal microbiota transplantation (FMT) is now an established treatment for recurrent Clostridioides difficile infection. There is also increasing evidence for the efficacy of FMT in inducing remission for mild-moderate ulcerative colitis. However, for other indications, data for FMT are limited, with randomized controlled trials rare, typically small and often conflicting. Studies are continuing to explore the role of FMT for many other conditions, including Crohn's disease, functional gut disorders, metabolic syndrome, modulating responses to chemotherapy, eradication of multidrug resistant organisms, and the gut-brain axis. In light of safety, logistical, and regulatory challenges, there is a move to standardized products including narrow spectrum consortia. However, the mechanisms underpinning FMT remain incompletely understood, including the role of non-bacterial components, which may limit success of novel microbial approaches.