International Journal of Medical Advances and Discoveries

International Scholars Journal of Medical Advances and Discoveries | Vol. 16, No. 9, September 2025 | pp. 57–64

DOI: 10.46882/2025/IJMAD/000108

Clinical Review

Title: Targeted Microbiota Modulation via Fecal Microbiota Transplantation in Inflammatory Bowel Disease Management

Names of Authors: F. G. O'Connor¹, G. H. Kim²

Authors’ Affiliations: ¹Department of Gastroenterology, St. Jude Medical Institute, Dublin, Ireland; ²Department of Internal Medicine, Seoul National University, Seoul, South Korea

Abstract: Dysbiosis of the gastrointestinal microbiome is a central pathogenetic hallmark of inflammatory bowel disease (IBD), encompassing both Crohn's disease and ulcerative colitis. This review evaluates the evolving role of fecal microbiota transplantation (FMT) as a targeted biologic intervention designed to restore microbial diversity and induce clinical remission in refractory IBD cases. We examine the physiological mechanisms through which donor microbial consortia re-establish short-chain fatty acid (acetate, propionate, and butyrate) production, suppress mucosal pro-inflammatory cytokine expression (TNF-alpha, IL-1beta, and IL-6), and reinforce intestinal epithelial tight junction integrity. Clinical trial data indicate varying efficacy: while FMT demonstrates robust induction of steroid-free remission in mild-to-moderate ulcerative colitis (pooled remission rates approximating 45% to 52% following multi-donor preparations), efficacy in Crohn's disease remains less consistent, likely due to transmural inflammation and complex phenotypic heterogeneity. Critical parameters influencing success include donor screening rigor, delivery modality (colonoscopic infusion vs oral lyophilized capsules), and pre-FMT antibiotic conditioning regimens. Safety profiles remain manageable, with self-limiting abdominal cramping and low-grade fever occurring transiently in under 15% of recipients. Optimizing patient selection criteria and characterizing specific "super-donor" microbial signatures will be vital for transforming FMT from an experimental rescue therapy into a standardized, personalized treatment modality in IBD care pathways.

Keywords: Fecal microbiota transplantation; Inflammatory bowel disease; Ulcerative colitis; Microbiome dysbiosis; Remission induction

Manuscript Timeline: Received: 05 May 2025; Revised: 02 August 2025; Accepted: 19 August 2025; Published: 05 September 2025

Citation: O'Connor, F. G., & Kim, G. H. (2025). Targeted Microbiota Modulation via Fecal Microbiota Transplantation in Inflammatory Bowel Disease Management. International Journal of Medical Advances and Discoveries, 16(9), 57–64.

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