Intest Res.  2024 Jan;22(1):44-64. 10.5217/ir.2023.00085.

The practice of fecal microbiota transplantation in inflammatory bowel disease

• Arora U
• Kedia S
• Ahuja V

• KMID: 2551278
• DOI: http://doi.org/10.5217/ir.2023.00085

Abstract

Current evidence posits a central role for gut microbiota and the metabolome in the pathogenesis and progression of inflammatory bowel disease (IBD). Fecal microbiota transplantation (FMT) has been established as a means to manipulate this microbiome safely and sustainably. Several aspects of the technical improvement including pretreatment with antibiotics, use of frozen stool samples as well as short donor-to-recipient time are proposed to improve its response rates. Its efficacy in ulcerative colitis has been proven in clinical trials while data is emerging for Crohn’s disease. This review describes briefly the biology behind FMT, the available evidence for its use in IBD, and the host, recipient and procedural factors which determine the clinical outcomes.

Keyword

Fecal microbiota transplantation; Microbiota; Inflammatory bowel diseases; Microbiome manipulation therapy

Figure

• 

  Fig. 1. Overview of fecal microbiota transplantation (FMT) in inflammatory bowel disease (IBD). Fecal matter from a healthy donor is collected, processed, and administered into a patient with IBD through one of several routes, typically via colonoscopy. FMT, if engraftment is successful, modulates existing gut microbiota by promoting growth of eubionts and suppressing pathobionts, with downstream effects of promoting anti-inflammatory metabolites (such as short-chain fatty acids or secondary bile acids) and suppressing inflammatory metabolites (triacylglycerol and tetrapyrrole). The interaction with immune system is complex but generally suppresses aberrant inflammation.

• 

  Fig. 2. Factors that determine success of fecal microbiota transplantation (FMT) in inflammatory bowel disease (IBD). The figure shows several factors including selection of donor, FMT session frequency, choice of frozen versus fresh FMT, pretreatment with antibiotics, and different routes of administration, all of which have been found to affect success of FMT. These serve as guides to allow improvement in FMT technique and creation of an optimum protocol.

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