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STATUS OF ROLE OF MICROBIOTA AND FECAL MICROBIOTA TRANSPLANTATION IN CROHN'S DISEASE
Jai Singh
*, maryam aleissa, Micheal Luca, Ernesto Drelichman, Vijay Mittal, Jasneet S. Bhullar
Colon and Rectal Surgery, Ascension Providence Hospital Southfield Campus, Southfield, MI
Background: Crohn’s disease (CD) is an idiopathic, chronic, and recurrent inflammatory condition of the gastrointestinal tract. Recent studies have highlighted the potential role of gut microbiota in CD, particularly the phenomenon of dysbiosis—an imbalance in gut bacteria. While dysbiosis is consistently observed in CD, it remains uncertain whether it is a cause or a consequence of the disease. Given the association of dysbiosis with CD, the therapeutic potential of fecal microbiota transplantation (FMT) has been explored.
Methods: A systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed database to identify all relevant studies published between October 2014 and October 2024. Our inclusion criteria were randomized controlled trials, observational studies, and clinical trials related to microbiota and Crohn’s disease, written in English. Data from the selected studies were extracted and analyzed.
Results: An initial literature search yielded 45 articles, but only 6 met the inclusion and exclusion criteria. Among these, only one randomized controlled trial (RCT) compared fecal microbiota transplantation (FMT) with a sham transplantation in Crohn’s disease. Another RCT examined the difference in Crohn’s disease improvement based on the route of FMT administration, comparing esophagogastroduodenoscopy (EGD) with colonoscopy. In this study, all patients received FMT, and there was no control group. The remaining four articles were clinical trials, none of which included a control group.
Response was assessed through improvement in clinical symptoms and clinical remission, including steroid-free remission. The rate of clinical remission ranged from 55% to 87.5%. However, long-term follow-up of the patients who achieved 87.5% remission at 10 weeks showed that the remission rate dropped to 50% after 24 weeks. Improvement in clinical symptoms ranged from 68% to 76%. One study compared fresh FMT with frozen FMT and found that fresh FMT produced better outcomes. The study that examined different routes of FMT administration did not reveal any changes in the outcomes.
Conclusion: The current status highlights the potential role of gut microbiota and dysbiosis in CD, indicating that interventions like fecal microbiota transplantation (FMT) merit further study. Given the observed improvements in clinical symptoms and varying remission rates, further research is essential to clarify dysbiosis's role in CD and optimize FMT protocols for improved patient outcomes.
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