Alteration of the intestinal microbiome: fecal microbiota transplant and probiotics for Clostridium difficile and beyond

Abstract

Clostridium difficile infection is increasingly common with a high risk of recurrence despite antibiotic treatment. In cases of recurrent C. difficile infection, fecal microbiota transplant (FMT) is a highly effective treatment option promoting the restoration of normal gut microbiota. Furthermore, preliminary uncontrolled evidence demonstrates possible benefit of FMT in the management of some cases of inflammatory bowel disease and chronic constipation. In addition to presenting an overview of FMT, we discuss the role of probiotics, a more common approach to modifying the intestinal microbiome. Probiotics have been utilized broadly for many disease processes, including gastrointestinal, cardiovascular and allergic disease settings, although with limited and inconsistent results. Multiple potential areas for research are also identified.

Keywords::

• Clostridium difficile
• fecal microbiota transplant
• intestinal microbiome
• probiotics

Financial & competing interests disclosure

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.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Fecal microbiota transplant (administered via nasogastric tube, enema, colonoscopy) appears safe with the appropriate donor screening, with clinical efficacy approaching 95% for recurrent Clostridium difficile infection.

• • Limited data suggest possible efficacy of fecal microbiota transplant for treatment of inflammatory bowel disease and constipation-predominant irritable bowel syndrome.

• • For prevention of Clostridium difficile infection, some multistrain probiotics have demonstrated efficacy.

• • Patients with mild-to-moderate ulcerative colitis and pouchitis demonstrated decreased symptoms when treated with probiotics (VSL#3) alone and in combination with anti-inflammatory or immune-modulatory medications

• • Treatment with probiotics has resulted in decreased global irritable bowel syndrome symptoms, reduced surrogate markers of inflammation, improved cholesterol levels and variable clinical effects on allergic diseases.

• • Given the infectious risks, probiotics should be used cautiously, if at all, in immunosuppressed individuals