Fecal Transplant for Ulcerative Colitis: Does It Work?

For nearly three years, Edward Bondurant performed his own fecal transplants to treat ulcerative colitis. For his first attempt, he asked a friend to make the donations and had a doctor screen the feces. He would then carefully blend the sample before squeezing it up into his colon with an enema bulb.

Bondurant was doing well with the transplants until October 2014, when he developed a bacterial infection during a trip to visit his uncle. The infection caused his ulcerative colitis to spiral out of control, and he was eventually forced to have his colon removed. Despite what happened, the 56-year-old financial adviser has no regrets.

“I believe the fecal transplants helped me keep my colon for two to three years longer than I ever could have,” says Bondurant. “In the past, we thought that feces made us sick and antibiotics cured us. Now we know that antibiotics can make us sick and feces can cure us.”

Like Bondurant, a growing number of people in the inflammatory bowel disease (IBD) community — those with ulcerative colitis or Crohn’s disease — have taken matters into their own hands by experimenting with DIY fecal transplants. But there are some important questions about this practice that haven’t been fully answered. First and foremost, is it safe? And just as importantly, could transplanting someone else's feces into your digestive tract really be an effective treatment for ulcerative colitis?

The Basics of Fecal Transplantation

Fecal transplantation involves transferring stool (feces) from a healthy donor into the gastrointestinal tract of another person to help restore healthy gut microbes. It’s also known as a fecal microbial transplant or fecal microbiota transplantation, or as FMT for short.

The modern practice of fecal transplants has been around since at least the 1980s, when they were first used to treat recurrent C. difficile infections, as noted in an article in the Mayo Clinic Proceedings. C. difficile (Clostridium difficile, or C. diff) is a common hospital-acquired bacterial infection that can cause fever, diarrhea, and cramping — and in older adults or people with certain health conditions, it can be severe or even fatal, according to Johns Hopkins Medicine.

“Fecal transplant is a very effective treatment for C. difficile when the beneficial bacteria normally in your colon have been wiped out by the illness and antibiotics,” says Matthew J. Hamilton, MD, a gastroenterologist at Brigham and Women's Hospital and an assistant professor at Harvard Medical School in Boston.

When used to treat a C. diff infection, fecal transplantation typically involves depositing a solution containing donated stool into the colon through a colonoscopy, Johns Hopkins Medicine notes. Less commonly, it may be performed from the other direction — an upper endoscopy in which a tube is inserted through your nose and reaches into your small intestine. Other options may include swallowing capsules or receiving an enema containing donated stool.

Usually a fecal transplant involves bowel preparation ahead of time, according to Mount Sinai. This requires a number of steps, such as stopping antibiotics, drinking clear fluids and a bowel cleanse solution, and avoiding food and most liquids on the day of the procedure.

Treating Ulcerative Colitis With Fecal Transplants

Although Bondurant felt his DIY treatments were helpful, fecal transplants for ulcerative colitis and Crohn’s disease are still in the investigational stages. But the results of some studies have been encouraging.

A study published in the January 2017 issue of Inflammatory Bowel Diseases found that people with ulcerative colitis who received a combination of antibiotics and fecal microbiota transplantation (FMT) were able to reestablish a healthy gut bacteria population.

As noted in a research review published in the January 2018 World Journal of Gastroenterology, FMT may reduce the severity of ulcerative colitis by reducing the permeability of the colon. The transplanted bacteria can produce an increased amount of a material known as short-chain fatty acids, which help maintain what’s known as the intestinal epithelial barrier — a layer that separates the contents of your digestive tract from cells that are active in your immune system.

A handful of studies have looked at the effect of FMT on ulcerative colitis. In a research review published in the October 2019 Acta Gastro-Enterologica Belgica, researchers found four clinical trials that have evaluated the effectiveness of FMT for ulcerative colitis. These studies found that between 22 and 44 percent of people who underwent FMT experienced remission of ulcerative colitis, compared with 5 to 20 percent of people in control groups.

Still, doctors caution that people with ulcerative colitis should not attempt to perform the procedure themselves.

"I would not recommend that anyone perform home FMT, as there are many real and theoretical risks that should be discussed with an experienced practitioner before the patient considers this therapy," says Jessica R. Allegretti, MD, MPH, a gastroenterologist and the medical director of the Crohn’s and Colitis Center at Brigham and Women's Hospital and an associate professor of medicine at Harvard Medical School.

Currently, doctors who wish to use FMT as a treatment for anything other than C. diff infections must do so as part of a clinical trial authorized by the U.S. Food and Drug Administration (FDA). In 2022, the FDA granted approval to an FMT product for the first time, sold as Rebyota. This product is approved only for the treatment of C. difficile in people who have attempted or failed antibiotic treatment. At almost the same time, the FDA required stool banks used for FMT to operate under stricter requirements — but doctors can still use them to treat C. difficile and for authorized clinical trials, as the American Gastroenterologial Association notes.

Risks of Fecal Transplantation for Ulcerative Colitis

Dr. Hamilton and Dr. Allegretti warn that the do-it-yourself approach to fecal transplantation carries several potential risks in people with IBD.

• You could have a flare. Instead of improvement in their IBD symptoms, some people see their symptoms worsen after a fecal transplant.
• You could get an infection. In a clinical setting, stool samples go to a lab for screening before they are used in a fecal transplant. Donors’ blood is also tested for infection. Even screened fecal material has transmitted a serious infection in some cases — and this risk is much higher without screening.
• Standard doses aren’t established. With recurrent C. difficile, one or two transplants can be enough to cure the infection. For IBD, it’s still unclear how often you might need treatments to keep symptoms controlled. While some FMT recipients with IBD maintain a similar gut bacteria profile to their donors for as long as 12 weeks, others show major differences after only 4 weeks, Hamilton and Allegretti noted in a 2014 article in the World Journal of Gastroenterology.
• Everyone’s IBD is different. Certain people might already have an underlying infection or a severe form of IBD, in which case fecal transplantation might put them at higher risk of serious infection.
• IBD treatments may conflict. Any medication you're taking that suppresses your immune system could put you at increased risk of an infection caused by an unscreened fecal transplant.

While research is starting to shed light on the potential benefits of fecal transplantation for IBD, it’s not even close to being ready for prime time. But if you’re still interested in this treatment, talk to your healthcare team about whether your condition, current medication status, and overall health make you a candidate for the procedure. You may be eligible for a clinical trial in which fecal transplantation is performed in a safe, controlled setting.

Additional reporting by Quinn Phillips.