In Reply We agree with Dr Benech and colleagues that, in our trial,1 ideally both donor and autologous FMT should have been processed under anaerobic conditions. Aerobic stool processing results in loss of many beneficial obligate anaerobic organisms such as Faecalibacterium prausnitzii.2 However, ours was an investigator-led trial with limited access to a single anaerobic chamber at only 1 center, making it impossible to process autologous FMT stool anaerobically at each trial site. We believe, however, that the risk of bias from this is minimal.
Costello SP, Conlon MA, Andrews JM. Fecal Microbiota Transplantation for Ulcerative Colitis—Reply. JAMA. 2019;321(22):2240–2241. doi:10.1001/jama.2019.3950
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