Manipulation of the microbiota for treatment of IBS and IBD-challenges and controversies.
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.
Alimentary Pharmabiotic Centre, University College Cork, National University of Ireland, Cork, Ireland; Department of Medicine, University College Cork, National University of Ireland, Cork, Ireland. Electronic address: F.Shanahan@ucc.ie.
Fergus
F
Shanahan
Alimentary Pharmabiotic Centre, University College Cork, National University of Ireland, Cork, Ireland; Division of Gastroenterology and Hepatology, Houston Methodist, Houston, Texas.
Eamonn M M
EM
Quigley
D000818:Animals; D001691:Biological Therapy / Q000009:adverse effects; D064806:Dysbiosis; D005243:Feces / Q000382:microbiology; D054884:Host-Pathogen Interactions; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000382:microbiology / Q000628:therapy*; D007422:Intestines / Q000382:microbiology*; D043183:Irritable Bowel Syndrome / Q000382:microbiology / Q000628:therapy*; D064307:Microbiota; D056692:Prebiotics / Q000009:adverse effects; D019936:Probiotics / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D056692:Prebiotics
Fecal Transplantation; Pharmabiotic; Prebiotic; Probiotic