International Session（Symposium）3(JSGE・JGES・JSGS・JSGCS)
Thu. November 5th   14:00 - 17:00   Room 11: Portopia Hotel South Wing Topaz
IS-S3-8_G
 Gut microbiota as a therapeutic target for IBD
Siew Ng
Department of Medicine and Therapeutics Institute of Digestive Disease, The Chinese University of Hong Kong
There are several ways to manipulate the microbiota in IBD including diet, prebiotics, probiotics and fecal microbiota transplantation. Exclusive enteral nutrition (EEN) can induce remission in pediatric Crohn's disease (CD) with a decrease in gut microbiome diversity after EEN treatment. Although there are some theoretical benefits, the actual treatment effects of prebiotics and probiotics in IBD patients can vary. Faecal microbiota transplantation (FMT) has been investigated as a potential treatment for inflammatory bowel disease (IBD). Unlike targeted therapies, FMT is “non-selective” and changes the entire microbiota, it makes no assumption about which part of microbiota drives inflammation including bacteria, viruses, fungi, archaea, proteins, chemical mediators or any interaction between these entities.
Randomized controlled trials (RCTs) and meta-analyses have reported that FMT facilitates clinical and endoscopic remission in patients with active ulcerative colitis (UC). Although the evidence for FMT in Crohn's disease (CD) is more limited, promising outcomes have been seen in small cohort studies. In a systematic review and meta-analysis of 53 studies, 36% of UC, 51% of CD, and 21.5% of pouchitis patients achieved clinical remission. Overall, no serious adverse events have been reported with a marginal increase in IBD flares after FMT in UC.
Microbiota analysis following FMT showed increased intestinal bacterial diversity and a shift towards the donor microbial profile in recipients' stools. Potential microbial parameters for donor selection to optimize the outcome of FMT is emerging. Donor bacterial species richness was associate with successful transplant whereas the presence of Fusobacterium in UC patients was associated with FMT failure. Other dark matters of the microbiome may be crucial for example cure after FMT for Clostridium difficile infections was associated with greater engraftment of Caudovirales from donor to recipient and the presence of Candida albicans leads to an unfavourable FMT response. Further large and well-designed trials are necessary to resolve optimal donor selection, duration, frequency of FMT, and the long-term sustained efficacy and safety.
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