COMMENTARY

Microbiome Makeover: Out With the Bad, In With the Good?

Digestive Disease Week (DDW) 2018

William F. Balistreri, MD

Disclosures

August 08, 2018

In This Article

Correction of Dysbiosis in Other Disorders

Manipulation of the microflora via FMT or probiotics was shown to be beneficial in other gastrointestinal diseases.

Nonalcoholic Fatty Liver Disease

Asfari and colleagues[7] conducted a meta-analysis to investigate the efficacy of probiotics for treating patients with nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH). PubMed and EMBASE were searched for relevant controlled trials published in the past decade comparing probiotics with placebo in a NAFLD/NASH population. Data were reported on 256 patients; 129 individuals given probiotics were compared with 127 individuals given placebo. Use of probiotics was associated with a significant improvement in aspartate aminotransferase and alanine aminotransferase levels compared with placebo.

Larger studies are still needed to investigate the effect of probiotics on histological improvement in patients with NAFLD/NASH.

Inflammatory Bowel Disease

Crothers and colleagues[8] investigated the safety, efficacy, and translational impact of FMT capsules in patients with active ulcerative colitis (UC). In a double-blind, randomized, placebo-controlled pilot trial, the treatment arm received FMT (used from selected donors and delivered initially by colonoscopy; 50 g of stool) followed by daily oral FMT (encapsulated; 0.375 g of stool). At week 12, histologic inflammation decreased in 66% of patients in the FMT arm versus 17% in the placebo arm. Histologic remission was achieved in 50% of the FMT recipients (none of the placebo recipients); endoscopic response was achieved in 43% of the FMT recipients (0% in placebo recipients); and clinical response was achieved in 29% of the FMT recipients (0% in placebo recipients).

These data suggest that FMT is safe and potentially decreases histologic, endoscopic, and clinical evidence of disease in patients with active UC. Specific donor features associated with the beneficial effect (microflora composition and short chain fatty acid content) were postulated.

Clostridium difficile Infection

In a recent report, Juul and colleagues[9] noted that FMT is more effective than current standard antibiotic therapy in the treatment of primary Clostridium difficile infection (CDI).

At this year's meeting, the same group reported the results of a study[10] in which hospitalized patients with diarrhea and a positive C difficile toxin stool test were randomized to either standard treatment (10 days of oral metronidazole 500 mg three times a day) or FMT (60 mL of anaerobically cultivated human intestinal microbiota). Primary resolution of CDI without recurrence within 70 days was observed in 56% of the FMT group versus 40% of the standard antibiotic group.

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