Reviews and feature article
The microbiome and inflammatory bowel disease

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Inflammatory bowel disease (IBD) is a chronic immune-mediated disease affecting the gastrointestinal tract. IBD consists of 2 subtypes: ulcerative colitis and Crohn disease. IBD is thought to develop as a result of interactions between environmental, microbial, and immune-mediated factors in a genetically susceptible host. Of late, the potential role of the microbiome in the development, progression, and treatment of IBD has been a subject of considerable interest and enquiry. Indeed, studies in human subjects have shown that the gut microbiome is different in patients with IBD compared with that in healthy control subjects. Other evidence in support of a fundamental role for the microbiome in patients with IBD includes identification of mutations in genes involved in microbiome-immune interactions among patients with IBD and epidemiologic observations implicating such microbiota-modulating risk factors as antibiotic use, cigarette smoking, levels of sanitation, and diet in the pathogenesis of IBD. Consequently, there has been much interest in the possible benefits of microbiome-modulating interventions, such as probiotics, prebiotics, antibiotics, fecal microbiota transplantation, and gene manipulation in the treatment of IBD. In this review we will discuss the role of the gut microbiome in patients with IBD; our focus will be on human studies.

Section snippets

The microbiome and inflammatory bowel disease

Inflammatory bowel disease (IBD) is a chronic immune-mediated disease affecting the gastrointestinal tract. The disease is thought to develop as a result of interactions between environmental, microbial, and immune-mediated factors in a genetically susceptible host (Fig 1). Several strands of evidence suggest a role for the microbiome in the pathogenesis of IBD (Table I). Data from a number of animal models provide a convincing argument for a fundamental role of an altered microbiome or an

Conclusions

The microbiome in patients with IBD is altered compared with that in healthy control subjects. There is robust evidence from animal models in particular to support a role for the microbiome in disease development and progression. Some, although limited, clinical data support the efficacy of treatment strategies that target the microbiome in patients with IBD. Current evidence supports the use of antibiotics to prevent postoperative recurrence in patients with CD, in the treatment of pouchitis,

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    Supported by the Fondren Foundation, Underwood Center for Digestive Disorders, William and Marie Wise, and Claudia and Jan Rask.

    Disclosure of potential conflict of interest: B. P. Abraham is a consultant for UCB, Takeda, Janssen, Pfizer, Medtronic, and Samsung Bioepis; has received research support from Janssen, Celgene, Genentech, Abbvie, UCB, and Takeda; and is on the speaker’s bureau for Janssen, UCB, Abbvie, Takeda, and Pfizer. E. M. M. Quigley is a consultant to Alimentary Health, Axon, Biocodex, and Salix. The rest of the authors declare that they have no relevant conflicts of interest.

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