Microbiota modulation-based therapy for luminal GI disorders: current applications of probiotics and fecal microbiota transplantation

ABSTRACT

Introduction: Alteration in the intestinal microbiota also termed as intestinal dysbiosis has been demonstrated in numerous gastrointestinal disorders linked to aberrant immune processes, acquisition of pathogenic organisms and often administration of antibiotics. Restoration of microbiota through probiotics and fecal microbiota transplantation (FMT) has gained tremendous popularity among researchers in the prevention and treatment of gastrointestinal diseases.

Areas covered: In this review, studies testing the safety and efficacy of probiotics and FMT for the treatment of various infectious and inflammatory luminal gastrointestinal diseases are reviewed. Randomized control studies are given priority while important uncontrolled studies are also highlighted.

Expert opinion: Probiotics have demonstrated efficacy in the prevention of antibiotic-associated diarrhea and in the eradication of Helicobacter pylori infection. Their utility in the primary and secondary prevention of Clostridioides difficile infection is debatable. The future of medicine should bring forth a personalized approach to probiotic use. FMT has revolutionized the treatment of recurrent CDI as well as severe and fulminant CDI. At the same time, it has galvanized gut microbiota research in the last decade. While FMT in ulcerative colitis appears promising, further studies on the durability and long-term safety are needed before it can be recommended in clinical practice.

KEYWORDS:

• Adverse events
• dysbiosis
• fecal microbiota transplantation
• intestinal microbiome
• probiotics

Article highlights

• Dysbiosis plays an important role in the pathogenesis of various gastrointestinal disorders.

• Probiotics are useful in the prevention of antibiotic associated diarrhea, C difficile infection and the eradication of H pylori infection.

• Probiotics are promising in UC, pouchitis and IBS but more robust studies are required to elucidate the safety and efficacy.

• FMT is well-tolerated and is currently recommended by professional organizations to treat antibiotic refractory C difficile infection.

• FMT results are encouraging in the induction of remission in active UC and treatment of fulminant CDI but rigorous studies with long term follow up are required for further recommendation.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.