By Dave DeFusco
At the Katz School’s recent Graduate Symposium on Science, Technology and Health, Ewa Gerlak, a student in the M.S. in Physician Assistant Studies, posed a question that has begun to reshape how physicians think about gastrointestinal health: Can fecal microbiota transplantation (FMT) offer a safer and more effective treatment for ulcerative colitis than traditional therapies?
Gerlak, with the assistance of Margaret Ewen, a clinical assistant professor in the PA program, highlighted an innovative and still-evolving therapeutic approach that’s beginning to challenge the status quo in inflammatory bowel disease treatment in a systematic review evaluating the clinical outcomes of FMT in adults with mild to moderately active ulcerative colitis (UC).
Ulcerative colitis, a chronic and often debilitating inflammatory bowel disease, affects the mucosal lining of the colon. Beginning at the rectum and extending proximally, the condition causes symptoms that include bloody diarrhea, cramping abdominal pain and tenesmus, or the frequent urge to defecate. Though the precise causes remain uncertain, current research points to a complex interplay of immune dysregulation, genetic susceptibility, environmental triggers and—most relevant to Gerlak’s work—microbiome imbalance.
“FMT is already well-established in treating recurrent Clostridium difficile infections,” said Gerlak. “But in recent years, researchers have been exploring its potential as a therapy for UC by restoring a healthy gut microbiome.”
Gerlak’s systematic review, “Effectiveness of Fecal Microbiota Transplantation for Acute Ulcerative Colitis: A Systematic Review of Clinical Outcomes,” followed established protocols for evidence-based medicine. She limited her literature search to peer-reviewed articles published between 2014 and 2024, drawing from Medline-PubMed and ScienceDirect.
The review ultimately included three clinical trials that met strict inclusion criteria: adult patients over 18 with Mayo scores between 4 and 10, signifying mild to moderately active disease. Stable doses of other medications were allowed to ensure a clean comparison of FMT against placebo or glucocorticoids (GCCs).
The review focused on two primary endpoints: clinical and endoscopic remission, alongside a comprehensive evaluation of safety profiles and adverse events. Across the three trials, Gerlak found compelling evidence that FMT was at least as effective as traditional glucocorticoid treatment in inducing remission—and in some cases, superior to a placebo.
“Two randomized controlled trials showed statistically significant improvements in both clinical and endoscopic remission in patients who received FMT compared to those who received a placebo,” said Gerlak.
When compared head-to-head with glucocorticoids, the gold standard for treating UC flares, FMT demonstrated similar remission rates but with a key advantage: a lower incidence of serious adverse events. In fact, while patients in the GCC groups experienced complications, including two who required colectomy, no serious events occurred in the FMT groups. Most FMT-related side effects were mild and transient, such as gastrointestinal discomfort and fever.
“This suggests that FMT not only works but does so with fewer risks,” said Gerlak.
While the results are promising, Gerlak was quick to acknowledge the limitations of the current evidence base. The three clinical trials included in the review featured small sample sizes, short follow-up durations and, in some cases, limited blinding or randomization—all of which affect the generalizability and long-term interpretation of the data.
“These are early days,” she said. “FMT is not yet a standard of care for UC, but the data suggest it’s a valuable candidate for further study.”
Gerlak’s research highlights a crucial shift in medicine—away from symptom management toward microbiome modulation where treatment targets not just inflammation, but its root causes in the gut ecosystem. Ewen praised Gerlak’s scholarship and dedication.
“Ewa’s work is a great example of how future PAs can contribute meaningfully to research that may one day transform clinical practice,” she said.
