What is the current evidence for fecal microbiota transplantation in dogs with GI disease?

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Fecal microbiota transplantation (FMT) has demonstrated clinical benefit across multiple canine gastrointestinal conditions, with the strongest evidence in chronic enteropathy (CE) and parvoviral infection, and emerging data in acute hemorrhagic diarrhea syndrome (AHDS). In dogs with CE, repeated or single rectal FMT consistently reduces disease activity scores. A single rectal FMT reduced the canine chronic enteropathy clinical activity index (CCECAI) from a median of 8 (range 5–14) at baseline to a median of 3 (range 1–12) at day 7 and a median of 1 (range 0–12) at day 30, with an average response duration of approximately 10 weeks.1 In a separate cohort of 20 CE dogs treated with 1–2 rectal FMTs, the canine inflammatory bowel disease activity index (CIBDAI) fell from a median of 5 (range 1–9) at baseline to a median of 1 (range 0–5) at 1 month and 1 (range 0–3) at 3 months, with 10 of 17 dogs with follow-up data remaining clinically stable at 6–12 months.7 In a larger retrospective series of 41 CE dogs treated with 1–5 rectal FMTs (median 3), 31 dogs responded, with CIBDAI falling from a median of 6 (range 2–17) to a median of 2 (range 1–9).7 Dogs with less severe dysbiosis at baseline had longer-lasting responses than short-term responders or non-responders.7 Baseline dysbiosis index predicts FMT response in CE dogs. Dogs with a long-lasting response — defined as clinically stable for more than 12 weeks — had significantly less marked dysbiosis at baseline compared to short-term responders or non-responders.7 This mirrors findings in human ulcerative colitis, where patients responding to FMT had less depletion of core microbiota than non-responders.7 In parvoviral infection, FMT as an adjunct to standard care shortens hospitalization and accelerates diarrhea resolution. Among survivors, FMT combined with standard treatment (intravenous fluids and antimicrobials) produced a median hospitalization time of 3 days versus 6 days with standard treatment alone.9 Mortal