Fecal Microbiota Transplantation as Therapy for Inflammatory Bowel Disease

Introduction

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is a chronic relapsing condition. There are approximately 1.6 million Americans currently living with IBD, and as many as 70,000 new cases of IBD are diagnosed each year. Although the exact pathogenesis of IBD remains unclear, it is thought to be caused by a combination of genetic, environmental, and immunologic factors. There is a pathologic immune response in genetically susceptible individuals driven by an altered host gut microbiota (dysbiosis). Current medical therapy is aimed at suppressing the host immune system with medications such as steroids, immunosuppressant therapy, and biologics. Despite advances in medical treatment, many patients continue to live with active symptoms that affect their quality of life.

The commensal human intestinal microbiota is a complex ecosystem involved in a number of physiologic functions including production of nutrients, regulation of metabolism, and immune function. Alterations may contribute to chronic inflammatory and autoimmune diseases. Fecal microbiota therapy (FMT), also known as fecal microbiota transplantation, refers to the delivery of stool from a healthy individual into the intestines of a diseased individual with the hope to restore the intestinal microbiota and potentially cure a specific disease. FMT is a highly effective and safe method for the treatment of refractory and recurrent Clostridium difficile infection (CDI), with cure rates over 90% with a single infusion. Because of its high success for treating CDI, there has been increasing interest to study FMT for other gastrointestinal conditions associated with intestinal dysbiosis such as IBD. The aim of this chapter is to review the current literature on using FMT products in clinical practice for IBD patients.