Current Evidence for the Management of Inflammatory Bowel Diseases Using Fecal Microbiota Transplantation

Abstract

Randomized controlled trials (RCTs) and meta-analyses have suggested that FMT may facilitate clinical and endoscopic remission in patients with active ulcerative colitis (UC). Although the evidence for FMT in Crohn's disease (CD) is more limited, positive outcomes have been observed in small cohort studies. Most adverse events (AEs) were mild and included transient gastrointestinal symptoms. Serious adverse events (SAEs) did not differ significantly between the FMT and control groups, and a marginal increased rate of IBD flares following FMT was observed. Microbiota analysis following FMT showed increased intestinal bacterial diversity and a shift towards the donor microbial profile in recipients' stools. FMT for patients with IBD is promising as RCTs have shown the benefit of FMT for UC, although the efficacy of FMT for CD is less clear. Further large and well-designed trials are necessary to resolve critical issues such as the donor selection, the ideal route of administration, duration, frequency of FMT, and the long-term sustained efficacy and safety.

The Safety of Fecal Microbiota Transplantation for Crohn’s Disease: Findings from A Long-Term Study

“…Although we have reported the cost-effectiveness analysis of FMT in both CD and ulcerative colitis [ 23 ], further study is necessary because of the changed procedures and treatment strategy. The reported evidence of the efficacy and long-term safety of FMT is limited [ 24 ]. This is the significance of the national register for 10 years of evaluation of FMT in the USA [ 25 ] and the China Microbiota Transplantation System (CMTS) [ 26 ].…”

The Integrative Human Microbiome Project

“…PersPective reseArcH been implicated in IBD, potentially as a causative or risk factor 66,67 , as an explanation for heterogeneity in treatment response (that is, some individuals respond well to relatively benign aminosalicylates or corticosteroids whereas others still experience severe inflammation even after surgical intervention) 68 , or as a novel point of therapeutic intervention (for example, by transplantation of faecal microbiota 69,70 ). Although meta-omic techniques have been used to identify functionally consistent microbial responses that help to explain the gut microbiome's role as part of a pro-inflammatory feedback loop in the gut during disease 71 , and a few strains of microorganisms have been shown to be IBD-specific 72 , no comprehensive model of specific microbial, molecular, and immune interactions yet exists to explain the disease's onset and dynamic progression.…”

Fecal microbiota transplantation reconstructs the gut microbiota of septic mice and protects the intestinal mucosal barrier

“…This is similar to the previous analysis of FMT use in recurrent C. di cile infection and in ammatory bowel disease. It is believed that FMT can maintain the intestinal bacterial balance by increasing the diversity of the ora and restoring intestinal ora after external interference [32]. However, in the 7-day mortality observation FMT group, the richness and diversity of bacterial ora were lower compared with the FMT group at 24 and 48 h. As aforementioned, the dose and the number of infusions of FMT may have contributed to this result [32].…”