1. Hormone-dependent colitis concept and treatment status: Hormone-dependent ulcerative colitis refers to patients with ulcerative colitis who have been using hormone therapy for a long time and cannot stop hormone reduction successfully, or relapse within 3 months after hormone reduction. Long-term hormone use poses an additional risk to the patient’s condition, and it is a difficult problem for clinicians to effectively control ulcerative symptoms while freeing the patient from hormone dependence. As an important means to rebuild intestinal flora, “fecal transplantation” has been used in the clinical treatment of ulcerative colitis and has benefited some patients, but for patients with hormone-dependent ulcerative nodes, the value of a single fecal transplantation is limited. 2. Definition and steps of fecal transplantation step-up treatment strategy: The so-called “fecal transplantation step-up treatment strategy” is simply based on single or consecutive fecal transplants within a short period of time, and further combined with other treatments, such as hormones and biologics, to help patients control intestinal symptoms and leave hormone dependence. Step 1: The first fecal transplantation is observed for 3-7 days after treatment to assess the clinical response of the patient; if the improvement is not obvious, then step 2; Step 2: The second fecal transplantation is observed for 3-7 days to assess the clinical efficacy; if the patient still cannot benefit from the second fecal transplantation, then step 3; Step 3: A short course of hormone therapy (2-4 weeks after taper) is continued. If the treatment effect is obvious, then enter the follow-up observation plus maintenance treatment phase; if the treatment effect is not good, then switch to other treatment, such as continuing hormone treatment or switching to biological agent treatment. For all patients with poor outcomes during Step 1, Step 2 and Step 3 treatment, direct conversion (hormonal, biologic, etc.) is an option. J Transl Med: Fecal transplantation step-up treatment strategy This protocol is not a simple superimposition of three treatment steps, but has a 1+1+1>3 effect. Translated from GMFH website Kristina’s interview with Dr. Zhang: Kristina: Why did you think that these treatments for ulcerative colitis (in this case, hormones and FMT) could work together? Dr. Zhang: The idea for the fecal transplantation step-up strategy came from our observation of a patient with hormone-dependent ulcerative nodes who failed FMT and had to continue with hormonal therapy because the first FMT was not effective, but surprisingly, the patient benefited from the subsequent hormonal therapy and was able to stop the hormones. This phenomenon was so encouraging that we hypothesized that one or two consecutive FMT treatments followed by one hormone treatment might provide greater benefit to the patient. Kristina: Did you find any difference between patients who responded to step1, step2, and step3 treatments respectively? Invention Zhang: This is a difficult question to answer. In fact, we don’t know what the difference is between them. However, if a patient in a hormone-dependent state fails his first FMT treatment, it is much more likely that he will need to continue using hormones for the rest of his treatment. Kristina: You give patients daily dietary advice, what role do you think these diets play in the success of this treatment strategy? Invention Zhang: Dietary management plays a very important role in reducing relapses, and even though some patients are able to maintain remission after FMT treatment, they still need to be cautioned about strict dietary restrictions. Some patients may have difficulty in controlling their diet, which requires us to give them adequate medical health education.