Drastic advancement in the treatment for inflammatory bowel disease and fecal microbiota transplantation

Abstract

Inflammatory bowel disease refers to two main diseases: ulcerative colitis and Crohn's disease. The number of patients with both diseases in Japan has been increasing rapidly in recent years. Infliximab, an anti-TNF-α antibody, showed dramatic efficacy against inflammatory bowel disease, leading to a paradigm shift in the treatment strategy for inflammatory bowel disease. Since infliximab, drug development for inflammatory bowel disease has completely shifted to molecular targeted therapies. Although the cause of inflammatory bowel disease is unknown, it is hypothesized that environmental factors such as diet, in addition to genetic background, cause dysbiosis of the gut microbiota, which in turn abnormally activates the intestinal immune system and induces chronic inflammation in the gut. Fecal microbiota transplantation (FMT) has attracted attention as an attempt to correct dysbiosis and treat inflammatory bowel disease. Several randomized controlled trials have demonstrated the efficacy of FMT for ulcerative colitis. However, optimization of the administration method, donor selection, and frequency of administration is needed. Long-term outcomes and safety must also be verified.