SYSTEMATIC REVIEW article
Front. Microbiol.
Sec. Microorganisms in Vertebrate Digestive Systems
Volume 16 - 2025 | doi: 10.3389/fmicb.2025.1604571
This article is part of the Research TopicFecal Microbiota Transplants: challenges in translating microbiome research to clinical applicationsView all 24 articles
Fecal Microbiota Transplantation for Chronic Constipation: A Systematic Review and Meta-Analysis of Clinical Efficacy, Safety, and Microbial Dynamics
Provisionally accepted
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Background: Chronic constipation, a prevalent gastrointestinal disorder with limited treatment efficacy in refractory cases, has prompted exploration of fecal microbiota transplantation (FMT) as a novel therapeutic strategy. This systematic review and meta-analysis evaluate the efficacy, safety, and gut microbial dynamics of FMT in adults with chronic constipation.We systematically searched PubMed, Embase, Web of Science, and Cochrane Library up to January 2025, identifying 1,072 records. 9 studies (n=245 patients) met inclusion criteria for qualitative synthesis, with eight contributing to meta-analysis. Outcomes included constipation remission and improvement, stool metrics, quality of life, and microbiota changes. Random-effects models analyzed pooled remission rates, mean differences (MDs), and heterogeneity (I² statistics).Results: FMT achieved a 50.7% pooled remission rate (95% CI: 38.7-62.7%%) and 64.8% improvement rate (95% CI:51.4-76.3%). Significant improvements were observed in stool consistency (MD=1.32, 95% CI: 1.05-1.35), quality of life (GIQLI MD=32.19, 95% CI: 17.15-47.23), and symptom severity (Wexner MD=-4.83, 95% CI: --7.15--2.51). Post-FMT microbiota analyses revealed enrichment of beneficial taxa (Bifidobacterium, Prevotella; Firmicutesacteroidetes) and suppression of proinflammatory Enterobacteriaceae. Transient gastrointestinal adverse events (e.g., bloating:17.3%) resolved spontaneously, with no severe complications reported.Conclusions: FMT demonstrates clinically meaningful symptom relief and gut microbiota remodeling in chronic constipation, supported by favorable short-term safety. While heterogeneity in protocols and limited RCT data warrant caution, these findings advocate standardized FMT frameworks and confirmatory trials to optimize therapeutics for refractory constipation.
Keywords: fecal microbiota transplantation, Chronic constipation, gut microbiome, Microbiota remodeling, refractory constipation
Received: 02 Apr 2025; Accepted: 23 Jun 2025.
Copyright: © 2025 Gao, Zhu, Chen, Tong and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sheng Zhang, Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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