Long term management of ulcerative colitis with Faecal Microbiota Transplantation

Abstract

Gut microbiota has emerged a major player in the pathogenesis of ulcerative colitis (UC). Targeting dysbiotic microbiota with the aim to restore intestinal homoeostasis and alleviate disease is an attractive approach in patients with UC. Results with microbiota targeted therapies including probiotics, prebiotics, and antibiotics have however been inconsistent and lack reproducibility. Faecal Microbiota Transplantation (FMT) is a novel microbiota centered therapy that has shown promise (in both efficacy and safety) with its short term use in UC. FMT appears to have bright prospects for long term management of UC due to its multi-pronged attack on the pathophysiological mechanisms involved in pathogenesis of UC. However, only limited data is available on its long term use in UC. We discuss important unsettled issues concerning use of FMT as a long term therapy. Various attributes related to FMT procedure, namely preparation of fecal slurry, frequency and duration of intervention, acceptability and safety, are analysed. Additionally we also explore the issues concerning patient and donor selection and the impact of habitual diet on results with FMT.