This prospective study included 22 adult horses treated at two separate referral hospitals (L1: n = 12; L2: n = 10), which either presented with or developed moderate to severe diarrhea (pudding to watery quality) while hospitalized, consistent with a diagnosis of colitis. Horses at both locations that developed diarrhea after presentation, did so within 48 hours of hospitalization, indicating that, though they were not yet producing diarrhea, their colitis may have contributed to their presenting complaint. All enrolled horses remained in the study unless another primary diagnosis, outside of colitis, was established. Fecal microbiota transplantation was performed in all 12 patients on 3 consecutive days at L1, while treatment of horses with diarrhea at L2 was based on standard care, without FMT. Horses with a history of reflux within 3 days prior to intended enrollment, recovering from colic surgery, or horses younger than two years of age were excluded. The obtained clinical data included: signalment, presenting complaint, predisposing factors such as antibiotic or non-steroidal anti-inflammatory therapy, recent long-distance travel, anesthesia, feed changes, prior enteral treatment with mineral oil, surfactants, or cathartics, duration of diarrhea, development of complications such as laminitis or thrombophlebitis, length of hospitalization, and outcome. Diarrhea frequency and quality was recorded every 6 h in colitis horses throughout the duration of the study. Diarrhea scoring was performed on a scale of 0–5 according to the following guidelines: 0—Normal, firm but moist balls of manure; 1—Soft-formed balls of manure that lose their form upon reaching the ground; 2—Pudding-consistency manure that still holds some shape; 3—Pudding-consistency manure that spreads out upon reaching the ground; 4—Watery manure with some formed pieces; 5—Watery manure without formed pieces.

Resolution of diarrhea was determined by the timepoint when manure quality reached a grade of 1 (soft-formed balls of manure that lose their form upon reaching the ground) or better, with no worsening of consistency throughout the remainder of the study period. Final outcome was characterized by survival (discharged alive) or non-survival (euthanasia or natural death).

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