Any Future for Fecal Microbiota Transplantation as Treatment Strategy for Inflammatory Bowel Diseases?

Abstract

Fecal microbiota transplantation (FMT) is a novel therapeutic procedure aiming at restoring a normal intestinal microbiota by application of fecal microorganisms from a healthy subject into the gastrointestinal tract of a patient. FMT is the most effective treatment for recurrent Clostridium difficile infections (CDI). These infections also occur in patients with inflammatory bowel diseases (IBDs), where case series demonstrated a successful treatment of CDI by FMT in 83-92% of patients. The effect of FMT on the activity of IBD has mainly been investigated in ulcerative colitis (UC) patients, including 3 randomized controlled trials. So far, 2 randomized controlled trials showed a superiority of FMT compared to placebo in inducing remission in UC, while 1 study found no significant difference to placebo. The variation in response to FMT between these studies as well as in the uncontrolled trials might be explained by many differences in the way of FMT application, patient pretreatment and patient and donor selection. The data for the use of FMT in Crohn's disease and pouchitis are sparse; currently, no conclusion can be drawn regarding the effectiveness of FMT in these indications. It needs to be noted that cases of IBD activation after FMT have been reported. So far, FMT can only be recommended to be used for the treatment of concomitant CDI in IBD in clinical practice. For treating IBD irrespective of CDI, FMT should be only used in clinical trials. Current forms of FMT, especially protocols using repeated application, are very time and personnel consuming. Future trends are the use of defined stable microbiota preparations, in particular oral preparations, which will enable better and larger controlled trails for investigating FMT in IBD.

Fecal microbiota transplantation is a rescue treatment modality for refractory ulcerative colitis

“…Several clinical trials of FMT for CDI suggest that nasoduodenal route is either associated with higher adverse effects or lower efficacy of FMT because some bacteria species of donor microbiota would not resist the gastric and bile acidity. [17–19] Retention enema may not allow sufficient time for colonization compared with ileal infusion. Our findings, as well as available data, suggest that ileal infusion of feces from healthy donor by the colonoscopy is a safe and tolerable treatment option for patients with UC.…”

Antibiotic-Associated Apoptotic Enterocolitis in the Absence of a Defined Pathogen: The Role of Intestinal Microbiota Depletion*

“…Dangers are related mostly to the application form of FMT (36, 37), like aspiration of fecal suspension after application into the upper gastrointestinal tract, leading to severe pneumonia and death (39, 40). In contrast, application into the lower gastrointestinal tract seems to have a better safety profile (36, 41). Nevertheless, translocation of microorganisms leading to septicemia poses a severe complication that needs to be considered.…”

Intestinal Microbiota Transplantation in Children

“…Rheumatoid arthritis, ankylosing spondylitis [76], and even caesarean sections [77]. As we see, there are many diseases that dysbiosis causes, so the first thing to do is ensure that dysbiosis does not develop and, if the conditions should occur anyway, we must have: Prebiotics, probiotics and symbiotics [78][79][80], Mediterranean diet, or resort, with all caution, given the presence of COVID-19, to Intestinal Microbiota Transplantation [IMT] [81][82][83]. Of course, if we have super donors, the IMT will be more beneficial [84].…”