Faecal microbial transplantation in inflammatory bowel disease
The etiopathogenesis of inflammatory bowel disease (IBD) is not yet fully understood. One theory proposes that IBD onset is an overreaction of the gut immune system to some parts of the gut microbiome. Thus, one therapeutic approach is to employ a faecal microbiota transplant (FMT) to change the composition of the gut microbiome. FMT involves transplanting fecal matter or stool from a healthy donor to a recipient, leading to the reestablishment of gut microbiome homeostasis for a certain period of time. FMT is a standard, clinical procedure that is highly effective for the treatment of recurrent clostridium difficile colitis. FMT in IBD is an experimental method used only in clinical trials. Recent studies have shown that FMT has a highly variable effect on disease remission and clinical response. Two randomized control studies providing no compelling evidence for the effectiveness of FMT in patients with ulcerative colitis have been published recently. However, studies of FMT treatment of ulcerative colitis suggest that beneficial effects depend on the donor having a rich and diversified microbiome, method of administration, and the frequency of FMT. Finally, the effectiveness of FMT treatment of Crohn’s disease has not yet been investigated thoroughly; however, the data so far indicate minimal beneficial effects of FMT for Crohn’s disease patients. To sum up, FMT is a safe method with minimum adverse effects when the donor is carefully selected. Although FMT treatment of ulcerative colitis is only moderately effective, it represents a safe and promising therapeutic approach. However, there is an urgent need for a more thorough investigation of FMT in larger cohorts of patients to clarify the effectiveness, remission induction rate, necessary number of FMT, long term safety, and proper application of FMT.
KeywordsCrohn’s disease, faecal bacterial transplantation, inflammatory bowel disease, clostridium difficile colitis, microbiome, ulcerative colitis
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