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. 2023 Nov 19;11(11):2806.
doi: 10.3390/microorganisms11112806.

Efficacy, Safety, and Concerns on Microbiota Modulation, Antibiotics, Probiotics, and Fecal Microbial Transplant for Inflammatory Bowel Disease and Other Gastrointestinal Conditions: Results from an International Survey

Tommaso Lorenzo Parigi  1   2 , Sophie Vieujean  3 , Kristine Paridaens  4 , Kira Dalgaard  5 , Laurent Peyrin-Biroulet  6   7   8   9   10   11 , Silvio Danese  1   2
Affiliations

Efficacy, Safety, and Concerns on Microbiota Modulation, Antibiotics, Probiotics, and Fecal Microbial Transplant for Inflammatory Bowel Disease and Other Gastrointestinal Conditions: Results from an International Survey

Tommaso Lorenzo Parigi et al. Microorganisms. .

Abstract

The gut microbiota play a pivotal role in human health. Dysbiosis, alterations in microbiota composition and function, is associated with gastrointestinal disorders, including inflammatory bowel disease (IBD). This international survey aimed to assess physicians' experiences, perceptions, and practices related to microbiome modulation for gastrointestinal conditions, with a focus on IBD. Results from 142 healthcare professionals, predominantly gastroenterologists, confirmed a consensus on the relevance of the gut microbiota in IBD pathogenesis. However, the utilization of microbial composition analysis and probiotics in clinical practice was limited, primarily due to the lack of standardized guidelines and supporting evidence. Physicians held conflicting views on antibiotics, recognizing their potential for inducing remission but also causing flares in IBD. Respondents also had varying opinions on the efficacy of fecal microbiota transplantation (FMT) for different gastrointestinal conditions, with higher confidence in FMT effectiveness for irritable bowel syndrome with diarrhea, pouchitis, and ulcerative colitis. Concerns on FMT included uncertainty about effect duration, administration intervals, and conflicting evidence. Donor selection was believed to be a crucial factor in FMT outcomes. This survey highlights the need for further research and evidence-based guidelines to optimize the use of microbiome-based therapies in clinical practice. As our understanding of the gut microbiome continues to evolve, these insights will contribute to more informed and personalized approaches to managing gastrointestinal disorders.

Keywords: Crohn’s disease; antibiotics; fecal microbial transplant; inflammatory bowel disease; irritable bowel syndrome; microbiota; pouchitis; probiotics; ulcerative colitis.

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Conflict of interest statement

T.L. Parigi has received speaker fees from Abbvie, Ferring, Fresenius Kabi, Takeda, and Tillots. S. Vieujean has received speaker fees from Abbvie, Janssen, Takeda, and Ferring. L. Peyrin-Biroulet reports personal fees from Galapagos, AbbVie, Janssen, Genentech, Ferring, Tillots, Celltrion, Takeda, Pfizer, Index Pharmaceuticals, Sandoz, Celgene, Biogen, Samsung Bioepis, Inotrem, Al-lergan, MSD, Roche, Arena, Gilead, Amgen, BMS, Vifor, Norgine, Mylan, Lilly, Fresenius Kabi, OSE Immunotherapeutics, Enthera, Theravance, Pandion Therapeutics, Gossamer Bio, Viatris, and Thermo Fisher; grants from Abbvie, MSD, Takeda, and Fresenius Kabi; and stock options from CTMA. S. Danese has served as a speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson and Johnson, Millenium, Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma, and Vifor. K. Paridaens and K. Dalgaard are employees of Ferring Pharmaceuticals.

Figures

Figure 1
Figure 1
Country of work, practice setting, and experience of survey respondents.
Figure 2
Figure 2
Use of microbiota composition analysis and reasons for non-use.
Figure 3
Figure 3
Frequency of probiotic use for different gastrointestinal conditions.
Figure 4
Figure 4
Perceived efficacy of fecal microbial transplant (FMT) for different gastrointestinal conditions.
Figure 5
Figure 5
Direct experiences of respondents on use of fecal microbial transplant, indications, observed efficacy, and ease and route of administration.
Figure 6
Figure 6
Perceived best use of fecal microbial transplant in IBD (top) and obstacles to its adoption (bottom).
See this image and copyright information in PMC

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