Inflammatory Bowel Disease (IBD, Crohn's and Colitis) and the Gut Biome

Research status: Medium

Inflammatory Bowel Disease (IBD) is characterized by chronic inflammation in the digestive system. In Ulcerative Colitis, this leads to long-lasting sores and ulcers in digestive tissues, specifically the lining of the large intestine and rectum. In Crohn's disease, the linings of digestive tissues become inflamed. Both illnesses are characterized by diarrhea, bloody stool, abdominal pain, fatigue and weight loss. 

The evidence suggests that changes in the gut microbiome can be therapeutic in promoting IBD remission. 

Selected scientific literature:

1. [Humans] Clinical trial: the microbiological and immunological effects of synbiotic consumption - a randomized double-blind placebo-controlled study in active Crohn's disease.

• “Randomized, double-blind, placebo-controlled trial. N = 35. Bifidobacterium longum, 2 × 10^11 CFU plus 6g of inulin/oligofructose (Synergy 1) were taken 2×daily for 6 months. Significant improvements in clinical outcomes occurred with synbiotic consumption, with reductions in both Crohn disease activity indices (P = .020) and histological scores (P = .018). Significant reductions occurred in TNF-α expression in synbiotic patients at 3 months (P = .041). Mucosal bifidobacteria proliferated in synbiotic patients."

2. [Human] Fecal microbial transplant effect on clinical outcomes and fecal microbiome in active Crohn's disease.

• "Nine patients, aged 12 to 19 years, with mild-to-moderate symptoms defined by Pediatric Crohn's Disease Activity Index (PCDAI of 10-29) were enrolled into a prospective open-label study of FMT in CD. Metagenomic evaluation of stool microbiome indicated evidence of FMT engraftment in 7 of 9 patients. The mean PCDAI score improved with patients having a baseline of 19.7 ± 7.2, with improvement at 2 weeks to 6.4 ± 6.6 and at 6 weeks to 8.6 ± 4.9. Based on PCDAI, 7 of 9 patients were in remission at 2 weeks and 5 of 9 patients who did not receive additional medical therapy were in remission at 6 and 12 weeks. No or modest improvement was seen in patients who did not engraft or whose microbiome was most similar to their donor."
  

3. [Human] A randomized controlled trial on the efficacy of synbiotic versus probiotic or prebiotic treatment to improve the quality of life in patients with ulcerative colitis.

• "Randomized controlled trial. N = 120. Bifidobacterium longum 2 × 10^9 CFU and 8 g doses of psyllium. The primary endpoint was scores on the IBD Questionnaire, which assesses health-related quality of life in IBD at 4 weeks. Results showed a statistically significant improvement in scores (168 to 176; P = .03) for the synbiotic group at the end of the study compared with patients on probiotic or prebiotic treatment alone. These data suggest that synbiotic therapy may have a synergistic effect in the treatment of UC."
  

4. [Review/Meta analysis] Fecal microbial transplant effect on clinical outcomes and fecal microbiome in active Crohn's disease.

• "Nine patients, aged 12 to 19 years, with mild-to-moderate symptoms defined by Pediatric Crohn's Disease Activity Index (PCDAI of 10-29) were enrolled into a prospective open-label study of FMT in CD. Metagenomic evaluation of stool microbiome indicated evidence of FMT engraftment in 7 of 9 patients. The mean PCDAI score improved with patients having a baseline of 19.7 ± 7.2, with improvement at 2 weeks to 6.4 ± 6.6 and at 6 weeks to 8.6 ± 4.9. Based on PCDAI, 7 of 9 patients were in remission at 2 weeks and 5 of 9 patients who did not receive additional medical therapy were in remission at 6 and 12 weeks. No or modest improvement was seen in patients who did not engraft or whose microbiome was most similar to their donor."