Fecal microbiota transplantation and peri-stoma microbiome management in patients with intestinal stomas: from mechanisms to clinical translation.

Background: Fecal diversion-induced dysbiosis in the defunctioned intestinal segment represents a common pathogenic basis for diversion colitis, anastomotic leakage, and long-term metabolic sequelae in patients with permanent stomas. This review proposes the novel concept of "Peri-stoma Microbiome Management (PSMM)" and critically evaluates the clinical evidence for fecal microbiota transplantation (FMT), defined microbial consortia, bacteriophages, and postbiotics. It is important to emphasize that PSMM is a proposed conceptual framework; most of its components have not been prospectively validated in stoma patients. Main body: The core pathological process involves a dramatic reduction in butyrate-producing obligate anaerobes, depriving colonocytes of their primary energy substrate. In experimental models, butyrate depletion impairs mitochondrial function and autophagic flux, with subsequent NLRP3 inflammasome activation; whether this pathway operates identically in the defunctioned human colon remains to be directly investigated. Collagenolytic pathobionts such as Conclusion: The PSMM framework provides a structured conceptual approach for integrating microbiome-targeted strategies into the care of patients with intestinal stomas. However, most interventions remain investigational and require validation in adequately powered randomized trials.