Abstract
Inflammatory bowel diseases (IBDs) result from dysregulated immune responses to environmental
and microbial triggers in genetically susceptible hosts. Many clinical observations
and animal studies support the role of the microbiome in the pathogenesis of IBD.
Restoration of the fecal stream leads to postoperative Crohn's recurrence, while diversion
can treat active inflammation. Antibiotics can be effective in prevention of postoperative
Crohn's recurrence and in pouch inflammation. Several gene mutations associated with
Crohn's risk lead to functional changes in microbial sensing and handling. However,
the evidence linking the microbiome to the IBD is largely correlative, given the difficulty
in studying the microbiome before disease occurs. Attempts to modify the microbial
triggers of inflammation have had modest success to date. Exclusive enteral nutrition
can treat Crohn's inflammation though no whole food diet to date has been shown to
treat inflammation. Manipulation of the microbiome through fecal microbiota transplant
and probiotics have had limited success. Further focus on early changes in the microbiome
and functional consequences of microbial changes through the study of metabolomics
are needed to help advance the field.
Keywords
inflammatory bowel disease - microbiome - Crohn's disease - ulcerative colitis
