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January 15, 2019

Manipulating the Microbiome With Fecal Transplantation to Treat Ulcerative Colitis

Author Affiliations
  • 1Warren Alpert Medical School of Brown University, Lifespan Physician Group Gastroenterology, Providence, Rhode Island
  • 2Massachusetts General Hospital and Harvard Medical School, Boston
JAMA. 2019;321(2):151-152. doi:10.1001/jama.2018.20397

Inflammatory bowel disease (IBD) is multifactorial, resulting from a complex interplay of genetic predisposition, environmental factors, immune dysregulation, and microorganisms within the intestine.1 Available therapies have focused almost exclusively on suppressing the aberrant host immune response. Although biologic agents have improved the clinical outcomes for patients with Crohn disease and ulcerative colitis (UC), concerns related to risk of infection and malignancy cause anxiety for clinicians and patients, who must be treated with these medications long-term. Patients with IBD have been shown to have alterations in gut microbiota such as lower diversity of microorganisms and increased numbers of proinflammatory and enteroadherent bacterial species,2 but whether these alterations are a cause or consequence of the disease state is unclear. Nevertheless, as the efficacy and safety of fecal microbiota transplantation (FMT) for treatment of Clostridium difficile infection (CDI) has become increasingly recognized,3 interest in FMT as a primary treatment for other conditions associated with imbalance in the intestinal microbiome, such as IBD, has also increased.

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