A narrative review on fecal microbiota transplantation routes in ulcerative colitis: identifying the optimal approach across key parameters.

Fecal microbiota transplantation (FMT) has gained increasing attention as a novel therapeutic approach for treating ulcerative colitis (UC), a chronic inflammatory bowel disease that causes an imbalance in the gut microbiota. Although FMT has demonstrated the potential to induce remission in UC patients, the most effective route of administration remains an area of active investigation. This narrative review provides a comprehensive comparison of different FMT delivery methods, such as oral capsules, enemas, colonoscopy, and nasogastric or nasoenteric tubes, across a range of clinically relevant parameters, including efficacy, safety, patient satisfaction, microbiota changes, pretreatment protocols, and cost-effectiveness. Furthermore, we examined how post-FMT dietary interventions may influence microbial engraftment and improve the long-term outcomes in patients with UC. In addition to assessing these practical and clinical factors, this review highlights the importance of patient-centered considerations, such as the tolerability and convenience of each administration route. The integration of these findings can provide valuable insights into how different FMT routes affect disease outcomes and guide clinicians in optimizing the treatment for individual patients. By synthesizing current evidence on these key variables, we aimed to identify the most effective and feasible FMT approach for UC. Establishing standardized protocols for FMT administration, informed by this analysis, will be crucial for ensuring consistency in clinical practice, improving patient outcomes, and minimizing adverse events. The insights from this review will help pave the way for more targeted and individualized FMT strategies, ultimately enhancing the therapeutic landscape of UC management.