Manipulation of the Microbiota for Treatment of IBS and IBD—Challenges and Controversies
Open accessAbstract
There is compelling rationale for manipulating the microbiota to treat inflammatory bowel diseases (IBDs). Although studies of animal models of intestinal inflammation produced promising results, trials in humans have been disappointing. In contrast to IBD, the role of the microbiota in the development of irritable bowel syndrome (IBS) only recently has been considered, but early stage results have been encouraging. As pharmaceutical companies develop fewer truly novel agents for treatment of these disorders, consumers seek safer, long-term strategies to deal with chronic symptoms. We assess the rationale for modulating the microbiota for treatment of IBD and IBS, and discuss whether current concepts are simplistic and overstated or simply under-researched. Are claims exaggerated and expectations unrealistic? Difficulties with microbiota terminology and technologies, as well as differences among patients and the heterogeneity of these diseases, pose additional challenges in developing microbiota-based therapies for IBD and IBS.
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In some instances, changed microbiota may be an appropriate response to a change in the host, or may represent an epiphenomenon without pathophysiological implications.
“In some instances, changed microbiota may be an appropriate response to a change in the host, or may represent an epiphenomenon without pathophysiological implications [22] .”
From Intestinal microbiota in health and disease: Role of bifidobacteria in gut homeostasis (2014) · cites this paper as [22]
Several limitations of FMT for PD remain, including standard clinical protocols, delivery methods, periodicity, donor selection criteria, patient inclusion criteria, long-term benefits and potential risks.
“Despite the therapeutic potential of FMT for the treatment of PD, several limitations still exist and need to be addressed. Standard clinical protocols, delivery methods, periodicity, donor’s selection criteria, patient’s inclusion criteria, long-term benefits and potential risks remain an issue [463,467,481,482,483,484,485].”
From The Interplay between Gut Microbiota and Parkinson’s Disease: Implications on Diagnosis and Treatment (2022) · cites this paper as [483]
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“Hence, food molecules and diverse microorganisms, including microbiota promote sustained activation of the mucosal immune system (Geremia et al. 2014; Shanahan and Quigley 2014; Vindigni et al. 2016).”
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“It is believed that they improve symptoms like abdominal pain and bloating by altering the intestinal microbiota, which may play an important role in the pathogenesis of IBS [116].”
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“Probiotics also facilitate TLR-mediated T-helper 1 cell differentiation, thereby also augmenting antibody production, increasing phagocytic and natural killer cell activity, and upregulating anti-inflammatory cytokine interleukin- (IL-) 10 and transforming growth factor beta while concurrently downregulating proinflam…”
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“tion of microbiota may be effective (3, 4).”
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“For probiotics with de fi nite e ff ects, it is recommended to investigate the bare minimum or precise probiotic required for speci fi c advantages, which would help normalize the treatment [122].”
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“Dysbiosis of gut b cteria is associated with various conditions, includi g obesity, diabe es, nonalcoholic fatty liver diseases, and autoimmune disorders [121,122], and even plays a significant role in I/R injury [123].”
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“These microorganisms in turnmay promote the release of pro-inflammatory factors such as TNF-α, which boost inflammation (Shawki and McCole, 2017).”
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“Identification of microbial biomarkers is a promising direction, not only for predicting IBD onset but also for predicting IBD risk factors [11].”
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“These strategies encompass antibiotics, prebiotics, probiotics, synbiotics, fecal microbiota transplantation (FMT), dietary modifications, and more [6].”
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“Changes in composition of microbiota and its metabolic functions are crucial for homeostasis of the immune system, and development of IBD.”
BackgroundInfluentialThe Gut-Brain Axis in Alzheimer’s Disease: Exploring Microbial Influences and Therapeutic Strategies
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“Standardizing therapeutic protocols, determining optimal administration duration, assessing short-and long-term risks, and establishing appropriate inclusion criteria are crucial steps before FMT can be considered a viable treatment option for AD [329–331].”
Baker, C. C., Sessenwein, J. L., Wood, H. M., Yu, Y., Tsang, Q. K., Alward, T. A., Jiménez-Vargas, N. N., Omar, A. A., McDonell, A., Segal, J. P., et al. (2024) · Cellular and Molecular Gastroenterology and Hepatology · doi:10.1016/j.jcmgh.2024.03.006 · Cited by 16 · see citing works
- Authors
- Shanahan, F., & Quigley, E. M. M.
- Affiliations
- National University of Ireland (IE)
- Houston Methodist (US)
- Corresponding author
- Shanahan, Fergus
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2014-05
- Volume
- 146
- Issue
- 6
- Pages
- 1554-1563
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2172135635
- Cited by
- 172
- References
- 67
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 7 · 2023: 7 · 2022: 11 · 2021: 12 · 2020: 12 · 2019: 17 · 2018: 13 · 2017: 20 · 2016: 27 · 2015: 22 · 2014: 17
- FWCI
- 2.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- gut microbiota, microbiota-based therapy, irritable bowel syndrome, inflammatory bowel disease, microbiota modulation, intestinal inflammation, disease heterogeneity
- MeSH terms
- Animals, Biological Therapy, Feces, Humans, Intestines, Inflammatory Bowel Diseases, Treatment Outcome, Probiotics, Irritable Bowel Syndrome, Host-Pathogen Interactions, Prebiotics, Microbiota, Dysbiosis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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