Rationale: There are many treatments for chronic hemorrhagic radiation colorectal inflammation, but only a few treatments are supported by high-quality research evidence. Studies have shown that the occurrence and development of radiation proctitis are closely associated with the intestinal flora. Animal studies have indicated that faecal microbiota transplantation (FMT) can improve radiation enteropathy in a mouse model. Patient concerns: A 45-year-old female patient suffered from recurrent hematochezia and diarrhea for half a year after radiotherapy and underwent recurrent transfusion treatments. Colonoscopy showed obvious congestion of the sigmoid colon and rectal mucosa, a smooth surface, and bleeding that was easily induced by touch, which are consistent with radiation proctitis. The pathological findings revealed chronic mucosal inflammation. The magnetic resonance imaging examination of the pelvic cavity with a plain scan and enhancement showed changes after radiotherapy and chemotherapy, and no obvious tumor recurrence or metastasis was found. The laboratory examinations excluded pathogen infection. Diagnoses: Based on the history and examinations, the final diagnosis of this patient was chronic hemorrhagic radiation proctitis. Interventions: The patient was treated with a total of 4 individual courses of FMT. Outcomes: After the six-month follow-up, her hematochezia, abdominal pain and diarrhea were relieved. Furthermore, 16S rRNA sequencing of the feces showed that the intestinal bacterial composition of the patient obviously changed after FMT and became similar to that of the donors. Lessons: This case report shows that FMT can relieve the symptoms of hematochezia and diarrhea by changing the bacterial community structure in patients with chronic hemorrhagic radiation proctitis.

As an emerging branch of clinical medicine, microbiota medicine has attracted worldwide attention from clinicians, medical educators, patient communities, and industry. However, this developing field still lacks consensus on its fundamental principles as well as guidelines for clinical and educational practice. An expert panel was convened by the journal Microbiota Medicine Research at the 2025 CHINAGUT Conference to develop the principles and practice guidelines of microbiota medicine using the Delphi method. This document provides a new framework for clinicians, educational institutions, and healthcare administrators. The expert panel developed 15 key statements, encompassing definitions of microbiota medicine and dysbiosis‐related diseases, graded value evaluation of microbiome testing technologies, pathways for multidisciplinary discussions on complex dysbiosis‐related diseases, and educational frameworks for physicians in microbiota medicine. The panel further recommends incorporating microbiota medicine into undergraduate and postgraduate medical education and emphasizes the application of artificial intelligence in supporting microbiota medicine. This guideline defines core competencies required for physicians specializing in this discipline. Collectively, this guideline aims to define the significant role of microbiota medicine in clinical practice and medical education, thereby advancing its sustainable development.

The pathogenesis of gastroesophageal reflux disease (GERD) is closely associated with the intestinal bacteria composition and their metabolites. To investigate whether washed microbiota transplantation (WMT) improves symptoms of nonerosive reflux disease (NERD) with proton pump inhibitor (PPI) dependency. Patients with recurrent NERD and PPI dependency at the First Affiliated Hospital of Guangdong Pharmaceutical University from 2017 to 2018 were included and divided into a WMT or PPI group treated with PPI with/without WMT. The endpoint was NERD symptom frequency evaluated 1 mo after WMT using reflux disease questionnaire (RDQ) and GERD questionnaire (GERDQ) scores, remission time, PPI dose, and the examination of intestinal mucosal barrier function. In the WMT (n = 15) and PPI (n = 12) groups, the total remission rate at 1 mo after treatment was 93.3% vs 41.7%. Compared with the PPI group, the WMT group showed better results in GERDQ (P = 0.004) and RDQ (P = 0.003) and in remission months (8 vs 2, P = 0.002). The PPI dose was reduced to some extent for 80% of patients in the WMT group and 33.3% in the PPI group. In 24 patients, intestinal mucosal barrier function was examined before treatment, and changes in the degree of damage were observed in 13 of these patients after treatment. Only one of the 15 patients had minor side effects, including a mushy stool two or three times a day, which resolved on their own after 1 wk. This study is the first to demonstrate that WMT may be safe and effective for relieving NERD symptoms and reducing PPI dependency and recurrence.

The new method of fecal microbiota transplantation, based on automatic facilities and washing processes, was coined as washed microbiota transplantation (WMT). The first recommendations on WMT were released as Nanjing Consensus report by the fecal microbiota transplantation (FMT)‐standardization Study Group in 2019. This is the second consensus report on WMT by the expert group of the CHINAGUT Conference. Delphi and grading of recommendations assessment, development, and evaluation (GRADE) systems were used to develop the consensus and appraise the quality of evidence and grading of recommendations. The present consensus named as Nanjing Consensus II with 28 statements was developed according to the preferred reporting items for microbiotherapy guidelines in 2024 (PRIM 2024) for improving the clinical use of WMT. The expert panel ranked the top 10 indications of WMT rather than voting on Clostridioides difficile infection. This consensus will promote the multidisciplinary application of WMT and advance the development of microbiota medicine.

Previous studies have found that hyperuricaemia (HUA) is closely related to intestinal flora imbalance. The current study investigated the effects and safety of washed microbiota transplantation (WMT) on serum uric acid (SUA) levels in different populations. A total of 144 patients who received WMT from July 2016 to April 2020 in the First Affiliated Hospital of Guangdong Pharmaceutical University and had SUA data before treatment were selected. Changes in SUA levels before and after treatment were retrospectively reviewed based on short-term and mid-term effects of WMT regimens. SUA levels measured in the last test within 3 mo after the first WMT represented the short-term effect, and SUA levels measured in the last test within 3-6 mo after the first WMT represented the mid-term effect. The patients were divided into an HUA group (SUA > 416 μM) and a normal uric acid (NUA) group (SUA ≥ 202 μM to ≤ 416 μM) based on pretreatment SUA levels. Average short-term SUA levels in the HUA group decreased after WMT (481.00 ± 99.85 vs 546.81 ± 109.64 μM, n = 32, P < 0.05) in 25/32 patients and returned to normal in 10/32 patients. The short-term level of SUA reduction after treatment moderately correlated with SUA levels before treatment (r = 0.549, R² = 0.300, P < 0.05). Average SUA levels decreased after the first and second courses of WMT (469.74 ± 97.68 vs 540.00 ± 107.16 μM, n = 35, and 465.57 ± 88.88 vs 513.19 ± 78.14 μM, n = 21, P < 0.05). Short-term and mid-term SUA levels after WMT and SUA levels after the first, second and third courses of WMT were similar to the levels before WMT in the NUA group (P > 0.05). Only 1/144 patients developed mild diarrhea after WMT. WMT reduces short-term SUA levels in patients with HUA with mild side effects but has no obvious effect on SUA levels in patients with NUA.