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image of man with Crohns

Note: If you haven’t read it, you may be interested in this comprehensive article on Crohn’s Disease and Diet.

Fecal microbiota transplantation (FMT) involves the replacement of the entire population of dysfunctional gut bacteria (gut microbiome) with healthy bacteria from healthy donor stool. The technique has been incredibly successful (90-98%) and safe for treating C diff infections caused by the bacteria Clostridia difficile. The question on everyone’s mind is what else can this procedure be used for. Clearly, conditions involving gut dysbiosis (unbalances in intestinal bacteria) make sensible targets. Early reports are promising for treating the other inflammatory bowel disease, ulcerative colitis, but what about Crohn’s disease?

Crohn’s disease is an inflammatory bowel disease (IBD) that affects approximately 600,000 people in the US.

[i] People who have Crohn’s suffer from a serious inflammation or irritation of their digestive tract which can lead to sores or ulcers forming, particularly near the end of the small intestine (called the ileum). The small intestine is where critical nutrient absorption takes place, so people with Crohn’s often don’t digest and absorb nutrients well. This can result in malnutrition, anemia and malabsorption of key vitamins and minerals such as vitamin B12, vitamin A, vitamin D, Vitamin E, vitamin K, folate, zinc, calcium and iron. The most common symptoms of Crohn’s include:

  • Severe watery diarrhea
  • Intense abdominal pain or cramping
  • Weight-loss
  • Fever
  • Fatigue

Despite extensive research, the exact cause of Crohn’s disease remains unknown. People with Crohn’s have various mutations (NOD2, ATG16L1, IL-23, IL12B, STAT3 and NKX2-3) in their genes that healthy people don’t have. Expression of the altered genes affects how bacteria interact with the intestinal surface and how our immune system interacts with these adherent bacteria.[ii] An imbalance in intestinal bacterial developing in response to the genetic abnormalities present in Crohn’s, may be the trigger for damaging inflammation characteristic of Crohn’s disease.

One thing is clear – People with Crohn’s have an altered microbiome suffering a 50% decrease in the diversity of gut microbes including the loss of bacterial species Bacteriodes, Eubacterium and Lactobacillus.[iii]A separate study also observed depletion of commensal bacteria, notably Firmicutes and Bacteroidetes bacterial types.[iv] A third study observed a decrease in Bacteroides bacteria and a decrease in bacterial end products. These studies point to a significant imbalance or gut microbes in people with Crohn’s disease. This imbalance may help explain the higher incidence of Clostridia difficile infection in people with inflammatory bowel disease.[v]

According to this CBS Boston News article, Dr. Alan Moss, Associate Professor of Medicine at Harvard Medical School and Beth Isreas Deaconess Medical Center is leading the effort to see if fecal transplantation can help people with Crohn’s disease. Though the results from this ongoing clinical trial are not available, one of the patients in the study had this to say: I see this as a major breakthrough in medicine by treating patients naturally, and it makes perfect sense. I’ve been eating and drinking whatever I want, and the Crohn’s symptoms I typically would have at this time are either minimal or nonexistent—symptoms such as sharp pain in my colon, cramps, bleeding ulcers, lethargy, joint pain, and diarrhea.”

Whether or not this treatment will work for Crohn’s, and how long the benefit will last are open questions, but there is reason to be optimistic.

[i] Kappelman MD, Moore KR, Allen JK, Cook SF. Recent trends in the prevalence of Crohn’s disease and ulcerative colitis in a commercially insured US population. Dig Dis Sci. 2013 Feb;58(2):519-25.

[ii] Podolsky DK. Inflammatory bowel disease. N Engl J Med. 2002 Aug 8;347(6):417-29.

[iii] S J Ott, M Musfeldt, D F Wenderoth, J Hampe, O Brant, U R Fo¨lsch, K N Timmis, S Schreiber. Reduction in diversity of the colonic mucosa associated bacterial microflora in patients with active inflammatory bowel disease. Gut 2004;53:685–693.

[iv] Frank DN, St Amand AL, Feldman RA, Boedeker EC, Harpaz N, Pace NR. Molecular-phylogenetic characterization of microbial community imbalances in human inflammatory bowel diseases. Proc Natl Acad Sci U S A. 2007 Aug 21;104(34):13780-5.

[v] Navaneethan U, Venkatesh PG, Shen B. Clostridium difficile infection and inflammatory bowel disease: understanding the evolving relationship. World J Gastroenterol. 2010 Oct 21;16(39):4892-904.

Note December 3, 2014: To Track this study, check out this link.