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Faecal microbiota transplantation with anti-inflammatory diet (FMT-AID) followed by anti-inflammatory diet alone is effective in inducing and maintaining remission over 1 year in mild to moderate ulcerative colitis: a randomised controlled trial
Open accessAbstract
Objective Microbiome and dietary manipulation therapies are being explored for treating ulcerative colitis (UC). We aimed to examine the efficacy of multidonor faecal microbiota transplantation (FMT) and anti-inflammatory diet in inducing remission followed by long-term maintenance with anti-inflammatory diet in patients with mild-moderate UC. Design This open-labelled randomised controlled trial (RCT) randomised patients with mild-moderate (Simple Clinical Colitis Activity Index (SCCAI) 3–9) endoscopically active UC (Ulcerative Colitis Endoscopic Index of Severity (UCEIS)>1) on stable baseline medications in 1:1 ratio to FMT and anti-inflammatory diet (FMT-AID) versus optimised standard medical therapy (SMT). The FMT-AID arm received seven weekly colonoscopic infusions of freshly prepared FMT from multiple rural donors(weeks 0–6) with anti-inflammatory diet. Baseline medications were optimised in the SMT arm. Clinical responders (decline in SCCAI>3) at 8 weeks in both arms were followed until 48 weeks on baseline medications (with anti-inflammatory diet in the FMT-AID arm). Primary outcome measures were clinical response and deep remission (clinical—SCCAI <2; and endoscopic—UCEIS <1) at 8 weeks, and deep remission and steroid-free clinical remission at 48 weeks. Results Of the 113 patients screened, 73 were randomised, and 66 were included in (35—FMT-AID; 31—SMT) modified intention-to-treat analysis (age—35.7±11.1 years; male—60.1%; disease duration—48 (IQR 24–84) months; pancolitis—34.8%; SCCAI—6 (IQR 5–7); UCEIS—4 (IQR 3–5)). Baseline characteristics were comparable. FMT-AID was superior to SMT in inducing clinical response (23/35 (65.7%) vs 11/31 (35.5%), p=0.01, OR 3.5 (95% CI 1.3 to 9.6)), remission (21/35 (60%) vs 10/31 (32.3%), p=0.02, OR 3.2 (95% CI 1.1 to 8.7)) and deep remission (12/33 (36.4%) vs 2/23 (8.7%), p=0.03, OR 6.0 (95% CI 1.2 to 30.2)) at 8 weeks. Anti-inflammatory diet was superior to SMT in maintaining deep remission until 48 weeks (6/24 (25%) vs 0/27, p=0.007). Conclusion Multidonor FMT with anti-inflammatory diet effectively induced deep remission in mild-moderate UC which was sustained with anti-inflammatory diet over 1 year. Trial registration number ISRCTN15475780 .
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“In another randomized trial of patients with UC, a combination of FMT plus an anti-inflammatory diet (AID) was more effective than standard medical therapy (SMT) in inducing disease remission, and AID was also”
From Key determinants of success in fecal microbiota transplantation: From microbiome to clinic (2023) · cites this paper as [107]
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Metadata
- Authors
- Kedia, S., Virmani, S., K Vuyyuru, S., Kumar, P., Kante, B., Sahu, P., Kaushal, K., Farooqui, M., Singh, M., Verma, M., Bajaj, A., Markandey, M., Sachdeva, K., Das, P., Makharia, G. K., & Ahuja, V.
- Affiliations
- All India Institute of Medical Sciences (IN)
- Corresponding author
- Ahuja, Vineet
- ORCID
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2022-08-16
- Volume
- 71
- Issue
- 12
- Pages
- 2401-2413
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- OpenAlex
- W4291993695
- Cited by
- 201
- References
- 42
- Citations by year
- 2026: 36 · 2025: 65 · 2024: 51 · 2023: 43 · 2022: 6
- FWCI
- 24.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Indian Council of Medical Research (55/4/11/CARE-ID/2018-NCD-II)
- Topics
- Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Gastroenterology › Microscopic Colitis
- Keywords
- fecal microbiota transplantation, anti-inflammatory diet, ulcerative colitis, deep remission, remission maintenance, steroid-free remission, dietary therapy, gut microbiota, endoscopic remission, clinical remission, inflammatory bowel disease treatment, quality of life
- MeSH terms
- Fecal Microbiota Transplantation, Anti-Inflammatory Agents, Colitis, Ulcerative, Diet, Humans, Male, Remission Induction, Treatment Outcome
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