IMPORTANCE High-intensity, aerobically prepared fecal microbiota transplantation (FMT) has demonstrated efficacy in treating active ulcerative colitis (UC). FMT protocols involving anaerobic stool processing methods may enhance microbial viability and allow efficacy with a lower treatment intensity. OBJECTIVE To assess the efficacy of a short duration of FMT therapy to induce remission in UC using anaerobically prepared stool. DESIGN, SETTING, AND PARTICIPANTS A total of 73 adults with mild to moderately active UC were enrolled in a multicenter, randomized, double-blind clinical trial in 3 Australian tertiary referral centers between June 2013 and June 2016, with 12-month follow-up until June 2017. INTERVENTIONS Patients were randomized to receive either anaerobically prepared pooled donor FMT (n = 38) or autologous FMT (n = 35) via colonoscopy followed by 2 enemas over 7 days. Open-label therapy was offered to autologous FMT participants at 8 weeks and they were followed up for 12 months. MAIN OUTCOMES AND MEASURES The primary outcome was steroid-free remission of UC, defined as a total Mayo score of Յ2 with an endoscopic Mayo score of 1 or less at week 8. Total Mayo score ranges from 0 to 12 (0 = no disease and 12 = most severe disease). Steroid-free remission of UC was reassessed at 12 months. Secondary clinical outcomes included adverse events. RESULTS Among 73 patients who were randomized (mean age, 39 years; women, 33 [45%]), 69 (95%) completed the trial. The primary outcome was achieved in 12 of the 38 participants (32%) receiving pooled donor FMT compared with 3 of the 35 (9%) receiving autologous FMT (difference, 23% [95% CI, 4%-42%]; odds ratio, 5.0 [95% CI, 1.2-20.1]; P = .03). Five of the 12 participants (42%) who achieved the primary end point at week 8 following donor FMT maintained remission at 12 months. There were 3 serious adverse events in the donor FMT group and 2 in the autologous FMT group. CONCLUSIONS AND RELEVANCE In this preliminary study of adults with mild to moderate UC, 1-week treatment with anaerobically prepared donor FMT compared with autologous FMT resulted in a higher likelihood of remission at 8 weeks. Further research is needed to assess longer-term maintenance of remission and safety.

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The development of sensitive and specific serological assays for celiac disease has led to a revision of the prevalence of this disease in many countries. In the Asia-Pacific region, prevalence has been determined in only a minority of countries but those with prevalence rates of 1:50-1:500 adults include Australia, Iran, Israel, New Zealand, Syria and Turkey. In contrast, celiac disease appears to be extremely rare in Japan and may be rare in China. In India, prevalence rates are high in the northern states but much lower in the southern states. In individual countries, important determinants of prevalence include the per capita consumption of wheat and the frequency of a specific human leukocyte antigen (HLA) type genetically defined as HLA-DQB1*02 (*0201 or *0202) and serologically defined as HLA-DQ2. These determinants predict low prevalence rates for celiac disease in the Pacific Islands, South-East Asia and eastern China but higher rates in countries west of India and China. There is also the potential for a rising incidence of celiac disease if traditional rice-based diets are replaced by Western-style diets with a higher content of wheat products.