For individuals grappling with ulcerative colitis (UC), a chronic inflammatory bowel disease, new research suggests a more effective path for receiving fecal microbiota transplantation (FMT). A recent study, dubbed STOP-Colitis, indicates that delivering FMT via colonoscopy—followed by self-administered enemas—yields significantly better results than the traditional nasogastric tube method. This finding offers a potential improvement in treatment outcomes and patient comfort for those seeking relief from this debilitating condition. The core of fecal microbiota transplantation lies in restoring a healthy balance of gut bacteria.
Ulcerative colitis affects the lining of the large intestine and rectum, causing symptoms like abdominal pain, bloody stools, and urgent bowel movements. Current treatments often involve medications to manage inflammation, but FMT is gaining traction as a potential way to address the underlying imbalance in the gut microbiome—the complex community of microorganisms living in the digestive tract. The promise of FMT for UC centers on the idea that introducing a healthy microbial community can correct dysbiosis, essentially re-establishing a more balanced and functional gut ecosystem. However, the optimal method for delivering these beneficial microbes has remained a subject of ongoing investigation.
Colonoscopy Outperforms Nasogastric Delivery in Pilot Study
The STOP-Colitis trial, conducted by researchers at the University of Birmingham Microbiome Treatment Centre in the UK, directly compared the two delivery routes. Thirty adults with active UC were randomly assigned to receive FMT either through a nasogastric tube or via colonoscopy followed by at-home enemas. The nasogastric group received four daily 50 mL infusions, while the colonic group received a single 250 mL administration during colonoscopy, supplemented by seven weekly 100 mL enemas. The results, published in Tech Coloproctol in April 2025, showed a markedly higher clinical response rate at week 8 in the colonoscopy group—75% compared to just 25% in the nasogastric group (RR=2.94; 95% CI, 0.84-10.30). Clinical remission rates as well favored the colonic delivery method, with 6 out of 12 patients achieving remission versus 2 out of 8 in the nasogastric arm.
Microbiome Shifts and Immune Response
Beyond the clinical improvements, the study revealed significant shifts in the gut microbiome composition of all participants who received FMT. Notably, responders—those who showed clinical improvement—experienced increases in the abundance of 24 different microbial species, including those from the phylum Firmicutes and the family Oscillospiraceae. Researchers also identified the presence of Firmicutes t__SGB15368, a species absent at the start of the trial, as a marker of microbial engraftment specifically in responders. This suggests that the successful establishment of certain bacterial species is crucial for treatment efficacy.
Further investigation into the immune response revealed that responders exhibited a reduction in Th17 cells—which promote inflammation—and an increase in gut-homing T regulatory cells (Tregs)—which help suppress inflammation—in the colonic mucosa. “Response was associated with reduction in Th17 cells (pro-inflammatory) and an increase in gut-homing T regs (anti-inflammatory) in the colonic mucosa,” explained Dr. Tariq H. Iqbal, the study’s lead author, according to Docwire News.
Safety and Tolerability
While both delivery methods were generally well-tolerated, adverse events occurred in the majority of patients. The most common side effects in the nasogastric group were abdominal pain and nausea, while the colonic group experienced diarrhea and abdominal pain. Importantly, two serious adverse events were reported in the nasogastric arm, but none were reported with colonic delivery. Dr. Iqbal also noted that patients found the colonic delivery method “much more acceptable” than the nasogastric tubes.
Future Directions and Ongoing Research
The researchers acknowledge that the study’s relatively small size and short follow-up duration limit its generalizability. The trial was not specifically designed to demonstrate efficacy, but rather to compare the two delivery routes. Despite these limitations, the findings provide valuable insights into optimizing FMT for ulcerative colitis. Dr. Iqbal and his team are now preparing to launch a new FMT study focusing on patients with newly diagnosed UC, aiming to further refine the understanding of how microbial manipulation can effectively treat this chronic condition. He emphasized that future function should focus on identifying the specific microbial actors involved in the treatment process, paving the way for the development of targeted live biotherapeutics and the integration of microbial treatments into standard IBD care.
Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
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