The Microbiome as a Therapy in Pouchitis and Ulcerative Colitis

Abstract

The gut microbiome has been implicated in a range of diseases and there is a rapidly growing understanding of this ecosystem’s importance in inflammatory bowel disease. We are yet to identify a single microbe that causes either ulcerative colitis (UC) or pouchitis, however, reduced microbiome diversity is increasingly recognised in active UC. Manipulating the gut microbiome through dietary interventions, prebiotic and probiotic compounds and faecal microbiota transplantation may expand the therapeutic landscape in UC. Specific diets, such as the Mediterranean diet or diet rich in omega-3 fatty acids, may reduce intestinal inflammation or potentially reduce the risk of incident UC. This review summarises our knowledge of gut microbiome therapies in UC and pouchitis.

Green Pea (Pisum sativum L.) Hull Polyphenol Extracts Ameliorate DSS-Induced Colitis through Keap1/Nrf2 Pathway and Gut Microbiota Modulation

“…Recently, many studies have shown that intestinal microbial balance is related to UC [2,12,13]. Compared with healthy people, the diversity and abundance of gut microbes in UC patients decreased, which was related to the increased risk of disease recurrence [14].…”

“…Ripened Pu-erh tea can promote the production of SCFAs, important gut microbial metabolites, to improve DSS-induced colitis [21]. The existing evidence suggests that a diet rich in bioactive substances can be a promising intervention strategy for the management of UC [13,17,18]. On the other hand, immune dysfunction caused by intestinal mucosal damage was considered one of the leading causes of UC [12,14].…”

Ileal Pouch–Anal Anastomosis and Pouchitis: The Role of the Microbiota in the Pathogenesis and Therapy

“…Furthermore, it has been shown that a combination of the two antibiotics can be effective also in patients with refractory/recurrent pouchitis [67]. The mechanisms implicated in the pouch microbiota's changes after antibiotic therapy that are responsible for their favorable effects are not clearly understood [38]. In the study of Gosselink et al, ciprofloxacin could eradicate pathogens that are significantly increased during pouchitis (Clostridium perfringens, hemolytic Escherichia coli) while not disrupting most of the anaerobic bacteria that contribute to the stability of the IPAA's flora [36].…”

“…Interestingly, the majority of the relapses occurred during or shortly after the completion of FMT [80,81]. Overall, only a few studies have explored the role of FMT in chronic pouchitis so far, exhibiting some pitfalls such as the heterogeneity in study design and type of fecal transplant delivery [38]. Future specifically dedicated RCTs with large sample-sizes and standardized protocols (i.e., disease definitions, type of FMT delivery, dose, or duration) will help to ensure reproducible data and provide higher quality of evidence on the real efficacy of FMT in the treatment of chronic pouchitis [82].…”

“…The etiology of pouchitis is mostly unclear. However, the efficacy of antibiotics in pouchitis suggests that the IPAA-related dysbiosis of the microbiota could play an important role in its pathogenesis [36][37][38]. We aimed to perform a comprehensive review on the role of the microbiota in the pathogenesis and as a target therapy In subjects with ulcerative colitis who develop pouchitis after undergoing total proctocolectomy with IPAA reconstruction.…”