Fecal Transplants Show Promise in Children With Inflammatory Bowel Disease

Fecal microbiota transplantation (FMT), a procedure that transfers processed stool from a healthy donor into a patient’s gastrointestinal tract, has been recommended as a treatment option for recurrent Clostridioides difficile infection (CDI). A retrospective study from Seoul National University Bundang Hospital examined FMT in pediatric patients with inflammatory bowel disease (IBD), including patients with recurrent CDI and patients without CDI. The findings, published in BMC Gastroenterology, draw on a decade of clinical experience at a single center.

From May 2013 through April 2023, pediatric patients with IBD who underwent FMT for recurrent CDI or for IBD without CDI at Seoul National University Bundang Hospital were retrospectively enrolled. In total, 18 patients were included: 11 with recurrent CDI and 7 without. Each patient received between one and four FMT sessions. Data regarding clinical characteristics, endoscopic findings, histopathologic findings, and long-term outcomes were collected and analysed.

The results paint a cautiously encouraging picture. The overall CDI eradication rate was 90.0%, meaning the infection was cleared in nearly all of the children treated for recurrent CDI. Beyond infection control, the mucosal healing rate, a measure of how well the intestinal lining recovered as seen through endoscopy, was 55.6%, and the clinical remission rate of IBD was 73.7%. These outcomes suggest that FMT may offer benefits that extend beyond simply eliminating a stubborn bacterial infection.

The study also tracked fecal calprotectin, a marker of intestinal inflammation measurable in stool samples. Baseline levels were markedly elevated, at a median of 3133.0 micrograms per gram (with a range spanning 64.0 to 6000.0 ug/g). After FMT, statistically significant decreases were observed at three days (median 2045.0 ug/g), one month (median 994.0 ug/g), and six months (median 251.5 ug/g), with a reported p-value of 0.009. The wide ranges indicate substantial variability between patients, but the downward trend across multiple time points points to a reduction in gut inflammation following the procedure.

In this cohort, adverse events were observed in 4 of 18 patients, or 22.2%. The authors conclude that FMT showed a high CDI eradication rate and was generally well tolerated in pediatric patients with IBD, with improvements in clinical and laboratory outcomes observed after the procedure.

The researchers themselves urge restraint in interpreting these numbers. Because the study was retrospective and exploratory in design, and because the sample size was limited to 18 patients at a single institution, the findings should be interpreted cautiously. The authors note that the accepted manuscript version of the article is subject to further edits before the final Version of Record.

Even so, the study adds meaningful evidence to a growing body of literature on microbiome-based therapies in children. It sits alongside earlier work on FMT for CDI in patients with IBD and a 2026 systematic review and meta-analysis of FMT response and risk factors in children.

The broader takeaway is that FMT appears feasible, generally tolerable, and potentially beneficial across both indications studied, recurrent CDI and IBD activity itself, in this pediatric population. Whether the observed improvements in remission rates, mucosal healing, and calprotectin levels will hold up in larger, prospective, controlled studies remains the critical open question. Until such trials are conducted, this ten-year single-center experience offers a foundation for future research rather than a basis for changing practice.

Subject of Research: Fecal microbiota transplantation outcomes in pediatric patients with inflammatory bowel disease with and without recurrent C. difficile infection

Article Title: Fecal microbiota transplantation in pediatric patients with inflammatory bowel disease with and without recurrent Clostridioides difficile infection: a 10-year retrospective cohort study

Article References: Hahn, J. W., Youn, J. W., Moon, J. S., Ko, J. S., & Yang, H. R. (2026). Fecal microbiota transplantation in pediatric patients with inflammatory bowel disease with and without recurrent Clostridioides difficile infection: a 10-year retrospective cohort study. BMC Gastroenterology. https://doi.org/10.1186/s12876-026-05432-x

Image Credits: AI Generated

DOI: 10.1186/s12876-026-05432-x

Keywords: fecal microbiota transplantation, pediatric IBD, Clostridioides difficile, retrospective cohort study, CDI eradication, fecal calprotectin, mucosal healing, adverse events, gastroenterology, Seoul National University Bundang Hospital, Fecal, microbiota