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Current Treatment Options in Gastroenterology

, Volume 17, Issue 1, pp 115–126 | Cite as

The Gut Microbiome as a Target for IBD Treatment: Are We There Yet?

  • Natalie C. Knox
  • Jessica D. Forbes
  • Gary Van Domselaar
  • Charles N. BernsteinEmail author
Inflammatory Bowel Disease (Gary Lichtenstein, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Inflammatory Bowel Disease

Abstract

Purpose of review

This review aims to highlight recent research on the gut microbiome in IBD and the application of microbiome-modulating therapies for the treatment of IBD including the use of the microbiome as an indicator for disease severity and treatment response.

Recent findings

Despite the high number of gut microbiome studies and emerging evidence supporting the gut microbiome’s involvement in disease pathogenesis, no single microorganism has been identified as a pathogenic agent in IBD. Retrospective studies and meta-analyses on antibiotic use in ulcerative colitis and Crohn’s disease and long-term outcomes are conflicting. Similarly, the use of probiotics for the treatment of IBD remains inconclusive; however, some encouraging results are emerging as microbial concoctions are optimized to include beneficial bacterial strains. Fecal microbial transplantation (FMT) is currently emerging as one of the more promising microbiome-modulating IBD therapies. FMT studies in ulcerative colitis have shown improved remission rates compared to placebo; however, relatively small study sample sizes and varied treatment methods, limit definitive conclusions.

Summary

With clear evidence of an IBD gut dysbiosis, novel therapies to treat and prevent disease relapse will undoubtedly require a microbiome-modulating approach. The complexity and variability of IBD disease pathogenesis (disease phenotype, gut microbiome, host genetic susceptibility, and environmental factors) will likely require a personalized and multidimensional treatment approach where microbiome-modulating therapy is coupled with other therapies to target other IBD disease components.

Keywords

Inflammatory bowel disease Gut microbiota Fecal microbiota transplant Antibiotics Probiotics Prebiotics Gut microbiome Microbiota-modifying treatment 

Abbreviations

CD

Crohn’s disease

CDI

Clostridium difficile infection

EEN

exclusive enteral nutrition (EEN)

IBD

inflammatory bowel disease

FMT

fecal microbiota transplantation

MD-index

microbial dysbiosis index

SCD

specific carbohydrate diet

UC

ulcerative colitis

Notes

Funding

Gary Van Domselaar receives operational funding from the Public Health Agency of Canada and has also received research support from the Multiple Sclerosis Society of Canada, the Canadian Institutes of Health Research, The National Sciences and Engineering Research Council, and Genome Canada.

Compliance with ethical standards

Conflict of interest

Charles Bernstein is supported in part by the Bingham Chair in Gastroenterology. He has served on advisory boards of Abbvie Canada, Ferring Canada, Janssen Canada, Pfizer Canada, Shire Canada, Takeda Canada, Napo Pharmaceuticals, and has consulted to 4D Pharm and Mylan Pharmaceuticals. He has received educational grants from Abbvie Canada, Janssen Canada, Pfizer Canada, Shire Canada, and Takeda Canada.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Natalie C. Knox
    • 1
    • 2
  • Jessica D. Forbes
    • 3
    • 4
  • Gary Van Domselaar
    • 1
    • 2
  • Charles N. Bernstein
    • 4
    • 5
    Email author
  1. 1.National Microbiology Laboratory, Public Health Agency of CanadaWinnipegCanada
  2. 2.Department of Medical Microbiology & Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada
  3. 3.Department of Laboratory Medicine & PathobiologyUniversity of TorontoTorontoCanada
  4. 4.IBD Clinical and Research CentreUniversity of ManitobaWinnipegCanada
  5. 5.Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegCanada

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