Fecal Microbiota Transplantation in 2025: Two Steps Forward, One Step Back

Area of Science:

• Gastroenterology and Microbiology
• Microbiome Therapeutics
• Clinical Practice Guidelines

Background:

• Fecal microbiota transplantation (FMT) has evolved significantly over decades.
• Recent years have seen major advances, including FDA approvals for FMT-based therapies.
• The American Gastroenterological Association (AGA) released guidelines in 2024 for FMT in gastrointestinal diseases.

Purpose of the Study:

• To review the history and current status of FMT.
• To emphasize FMT applications in Clostridioides difficile infection (CDI), inflammatory bowel disease (IBD), and irritable bowel syndrome (IBS).
• To clarify indications, evidence, and recommendations for FMT in 2025.

Main Methods:

• Review of historical data and current research on FMT.
• Analysis of FDA approvals and AGA practice guidelines.
• Assessment of FMT accessibility and evidence for various gastrointestinal conditions.

Main Results:

• FDA approved the first FMT-based therapies in 2022 and 2023.
• AGA guidelines provide recommendations for FMT in CDI, IBD, and IBS.
• Conventional FMT access is more challenging in 2025 due to supply changes, though it remains an option for CDI.
• FMT is established for CDI, but further evidence is required for IBD and IBS.

Conclusions:

• FMT is a standard therapy for many patients with CDI.
• While promising for IBD and IBS, FMT's routine use in these conditions requires additional supporting evidence.
• The landscape of FMT is dynamic, with ongoing developments in approved therapies and clinical guidelines.