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Therapeutic Manipulation of the Microbiome in IBD: Current Results and Future Approaches

  • Inflammatory Bowel Disease (G Lichtenstein, Section Editor)
  • Published:
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Opinion statement

Despite recent major strides in our understanding of the genetic and microbial influences that contribute to the development of the inflammatory bowel diseases (IBDs), their etiology continues to be enigmatic. Results from experiments in animal models of IBDs overwhelmingly support a causal role of the microbiota in these diseases, though whether such a cause-effect relationship exists in human IBDs is still uncertain. Therefore, virtually all currently approved and most often prescribed treatments for IBDs are directed toward the over-active immune response in these diseases rather than the intestinal bacteria. Nevertheless, there is an important need for non-immunosuppressive therapies that may present a more favorable risk-benefit profile such as those that selectively target the disruptions in gut microbiota that accompany IBDs. This need has led to clinical trials of various microbial-directed therapies including fecal microbial transplant, antibiotics, probiotics, and prebiotics. Unfortunately, these published studies, many of which are small, have generally failed to demonstrate a consistent benefit of these agents in IBDs, thus leading to slow acceptance of microbe-focused treatments for these conditions. In this article, we review and summarize the microbial basis for IBDs and the results of the most recent trials of fecal microbial transplant, antibiotics, probiotics, and prebiotics in IBDs. We also comment on possible safety concerns with these agents, speculate on why they have failed to show efficacy in certain clinical settings, and propose strategies to improve their usefulness.

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Conflict of Interest

Jonathan J. Hansen declares that he has no conflict of interest.

R. Balfour Sartor has received consulting fees/honorarium and paid travel accommodations from Dannon/Yakult and grants from Salix and GSK

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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Authors and Affiliations

  1. Department of Medicine, University of North Carolina at Chapel Hill, CB 7032, Chapel Hill, NC, 27599, USA

    Jonathan J. Hansen MD, PhD & R. Balfour Sartor MD

  2. Department of Microbiology & Immunology, University of North Carolina at Chapel Hill, CB 7032, Chapel Hill, NC, 27599, USA

    Jonathan J. Hansen MD, PhD & R. Balfour Sartor MD

  3. The Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, CB 7032, Chapel Hill, NC, 27599, USA

    Jonathan J. Hansen MD, PhD & R. Balfour Sartor MD

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  1. Jonathan J. Hansen MD, PhD
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  2. R. Balfour Sartor MD
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Correspondence to R. Balfour Sartor MD.

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This article is part of the Topical Collection on Inflammatory Bowel Disease

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Hansen, J.J., Sartor, R.B. Therapeutic Manipulation of the Microbiome in IBD: Current Results and Future Approaches. Curr Treat Options Gastro 13, 105–120 (2015). https://doi.org/10.1007/s11938-014-0042-7

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