Gut microbiota dysbiosis in the pathogenesis of ulcerative colitis and the therapeutic efficacy of fecal microbiota transplantation: a meta-analysis

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• Picked for Gastroenterology (top studies of the week, 19 July 2026): FMT efficacy meta‑analysis for ulcerative colitis
• Picked for Transplantation (top studies of the week, 19 July 2026): Meta-analysis of fecal microbiota transplantation for ulcerative colitis

Abstract

OBJECTIVE: To explore the correlation between gut microbiota dysbiosis and the pathogenesis of ulcerative colitis (UC), and to provide an evidence-based basis for clinical diagnosis and treatment. METHODS: Randomized controlled trials (RCTs) were included through a systematic search of the PubMed, Medline, Web of Science, Cochrane Library, and EMBASE databases. The Cochrane Risk of Bias Tool (RoB 2) was used to evaluate the quality of the literature. RevMan 5.3 software was employed to conduct a Meta-analysis, and the pooled effect size (OR/RR) and 95% confidence interval (CI) were calculated. The primary outcome measures included the associations between gut microbial diversity, changes in the abundance of specific microbial groups and the onset of UC. RESULTS: A total of 6 literatures were included, involving 171 study subjects (100 cases in the fecal microbiota transplantation (FMT) group and 71 cases in the control group), all of which were randomized controlled trials. There was no significant difference in the clinical response between the FMT group (ulcerative colitis patients receiving fecal microbiota transplantation intervention) and the control group (ulcerative colitis patients receiving conventional treatment or placebo) (RD = 0.17, 95% CI [-0.05-0.40], P = 0.14); the clinical remission in the FMT group was significantly better than that in the control group (OR = 2.20, 95% CI [1.05-4.59], P = 0.04); the changes in the microbiota composition in the FMT group were significantly higher than those in the control group (MD = 0.20, 95% CI [0.11-0.28], P < 0.001); there was no significant difference in the occurrence of adverse events between the FMT group and the control group (RD=-0.00, 95% CI [-0.15-0.14], P = 0.98); there was no significant difference in endoscopic remission between the FMT group and the control group (OR = 1.53, 95% CI [0.57-4.11], P = 0.40). CONCLUSION: This exploratory meta-analysis suggested that gut microbiota dysbiosis may be associated with the onset of UC, manifested as reduced diversity, imbalanced microbiota structure, and changes in the abundance of specific microbial groups. However, given the limited number of included studies, these findings are hypothesis-generating and require validation in larger, well‑powered trials. Further exploration of the potential value of microbiota intervention in the treatment of UC is needed.

Abstract as published, via PubMed.