June 6, 2023
Crohn’s affects 1.3 million Americans and its prevalence is rising globally. It is a disease with no cure; at the moment, treatment only exists to decrease Crohn’s Disease symptoms. Though there might be hope yet for a cure, and it comes in the form of poop.
Research is underway to explore Fecal Microbiota Transplants (FMT) as a possible therapy for Crohn’s Disease. The research is part of a larger movement towards the poop therapy - many are exploring the treatment for IBD and other sources of chronic GI symptoms
In this article we will explore poop transplants as a Crohn’s Disease treatment, and cover the following topics:
Let’s start with the basics on what causes Crohn’s, to determine how it could connect to a treatment using stool transplants.
Crohn’s Disease is a chronic illness affecting the GI tract. It is characterized by patchy inflammation throughout the GI tract, reaching from the mouth to anus. It is are often diagnosed before the age of 30 and because it is chronic, sufferers often go from acute flare ups to long periods of remission.
Crohn’s Disease is caused by both genetic and environmental components. More than 200 genetic markers have been identified as influencers, and there are known irritants including stress, smoking, certain foods, antibiotics, and certain anti-inflammatory drugs, but the root cause remains unknown.
The back and forth between acute inflammation and periods of remission and the unknown factors that contribute to those flare-ups is part of what makes the cause of Crohn’s so difficult to pinpoint. Researchers are now considering the role a disrupted microbiome might play in Crohn’s, and whether or not they can treat the disease by treating the microbiome.
Crohn’s Disease can affect the whole of the GI tract; because of this, symptoms reach to many parts of the body. Typical symptoms of Crohn’s include:
Those with Crohn’s might also suffer more severe symptoms such as inflammation of skin, eyes, joints, or liver. Some children with Crohn’s also experience delays in growth or sexual development.
Exploring the microbial component might be a step in the right direction for finding a Crohn’s Disease cure. So, what are the connections between the microbiome and the pathology of Crohn’s Disease?
The microbiome, which is all the bacteria, fungi, protozoa and viruses in our bodies, has a huge impact on the immune system, the GI system, and even the brain. The microbiome is composed of distinct microbial communities that live in our noses, ears, eyes, guts and on our skins.
The microbiome and Crohn’s have the GI system in common, but how do they specifically relate?
There is a documented connection between the gut microbiome and the symptoms of Crohn’s. Researchers have discovered that an unbalanced gut microbiome in those with Crohn’s might be at the core of many of their symptoms, and that a bad type of bacteria called Proteobacteria might be the cause of that unbalance.
Researchers are hoping that they will be able to repopulate the the microbiomes of those with this unbalance by way of a fecal transplant, and that the FMT will reduce flare ups in those with Crohn’s.
FMT is emerging as a promising treatment for Crohn’s. There is evidence that supports the idea that poop transplants might be the treatment that those with Crohn’s need, and have been waiting for. They believe it could help reverse the microbial ubalance that may be part of the core of Crohn’s.
A fecal microbiota transplant, or FMT, is a therapy where poop from a healthy donor is turned into a slurry and then implanted in
the gut of a sick patient. FMT works by replacing bad bacteria in the guts of patients with good bacteria from donors in hopes that the good will outperform the bad.
Dysbiosis of the gut microbiome has been found to be a contributing factor in Crohn’s disease. Fecal transplants are a viable treatment for gut microbiomes in dysbiosis. By treating this aspect of the body, doctors are hoping it will also relieve symptoms of Crohn’s.
Quick Fact: Dysbiosis is the imbalance of bacteria in the gut. Dysbiosis of the gut happens when the number of bad and harmful bacteria in the gut outnumber and outperform the good bacteria. FMT can help fix this imbalance by providing the gut microbiome with more of the good bacteria, to fight off the bad.
A case for the use of FMT in the treatment of IBD is made in a paper released by the Icahn School of Medicine at Mount Sinai in New York, NY. The authors advocate for the further study of FMT for the treatment of IBDs such as Crohn’s, providing convincing data to support their conclusions.
Who Worked on It: Dr. Joanna Lopez and Dr. Ari Grinspan at the Icahn School of Medicine at Mount Sinai in New York
Date Published: June 2016
Highlights of Results: In the analysis of 20 studies including case reports, cohort studies, and randomized, controlled trials on the use of FMT for IBD, it was found that nearly 61% of Crohn’s patients achieved clinical remission from the therapy.
What’s Next: The efficacy of FMT for the treatment of Crohn’s is still unclear. The authors of the paper conclude that more studies are required to determine the benefits of the treatment and if it is beneficial which components of it make it successful.
In a study out of the University of Pennsylvania, researchers were able to single out the bacterial enzyme behind the imbalances in the guts of those with Crohn’s Disease.
Who Worked on It: Researchers from the Perelman School of Medicine at the University of Pennsylvania, led by Dr. Gary D. Wu
Date Published: November 2017
Highlights of Results: Proteobacteria, bacterial enzymes, might be causing dysbiosis in the gut microbiomes of those with Crohn’s. The study explored the possibility of re-configuring the microbiome by wiping the slate clean through the use of antibiotics and PEG, which is used to clean out the colon before colonoscopies are performed. In wiping the gut clean, they were able to improve the symptoms of their patients.
What’s Next: Pinpointing this specific factor in the dysbiosis of those with Crohn’s might lead to new treatments being developed. Their hope moving forward is to then “redesign” the microbiome from the clean slate, restructuring of the gut microbiome to make it healthy and balanced moving forward.
Motivated by increasing evidence that dysbiosis is a common feature of patients with IBD, of which Crohn’s is a subdisease, research is moving towards how the microbiome can be altered. This case study out of The Catholic University of Korea used FMT in an attempt to repopulate the gut of a woman with Crohn’s who was unresponsive to regular therapies and suffering from extreme inflammation of the GI tract.
Who Worked on It: Researchers at the The Catholic University of Korea, in Seoul, Korea.
Date Published: April 2017
Highlights of Results: The patient, a 16 year-old girl, had a fever of 37.1℃ and was in poor condition when she was admitted into the hospital. She had been diagnosed with Crohn’s the year prior. At diagnosis the patient was put on biological therapies normally prescribed to those suffering from Crohn’s, which failed to control the disease. After consultation with her parents, she was given single FMT to treat the condition. The patient sustained clinical remission for more than 12 months, and follow up is ongoing.
What’s Next: The conclusion of the case study suggests that FMT be further studied and considered for the treatment of refractory Crohn’s Disease that is unresponsive to conventional therapies.
Access to a fecal transplant for Crohn’s is currently mostly limited to trials, with the exception of countries where FMT remains unregulated. At the moment, trials are the best way to receive FMT for Crohn’s. It is also crucial that if you can and are willing, you participate in these trials so that FMT can continue to be researched thoroughly.
If you are thinking of trying fecal transplants on your own, we strongly discourage it. Without proper testing that can only be done in a clinical setting, it is not possible to make sure that your donor is safe, or that it is safe for you body.
You can check out our list of clinics that specialize in FMT or you can check out our list of current FMT trials.
If you’re looking for more resources to help you learn about fecal transplants or Crohn’s Disease, check out these articles for further information.
Learn more about all of the resources available to help you learn more about fecal transplants, including current clinical studies, the best doctors, where to get FMT news, and more.
FMT Induces and Maintains Clinical Remission in Crohn’s Disease
A small study examined multiple fresh fecal microbiota transplants in a analysis of 25 patients with IBD. 52.0% of patients were able to achieve clinical remission 3 months post the first FMT.
Fecal Microbiota Transplantation in Patients with Inflammatory Bowel Disease
An interview with Dr Paul Moayyedi from the Gastroenterology Department at McMaster University in Hamilton, Ontario, Canada. Dr. Moayyedi discusses the progress of some of the departments studies on fecal transplants for the treatment of IBD.
Fecal Transplant Treatment for C Diff: Successes, Risks, and Rewards
FMT is an incredibly safe and effective treatment for the all too common Clostridium Difficile infection. Learn more about how fecal transplants work for C Diff and where they are being done.
How to Improve Gut Microbiome Health: Development from Infant to Adult
How your microbiome is developed can affect your health throughout your life, possibly leading to Chronic Illnesses like Crohn’s Disease. Learn about what’s being done to save the microbiomes of infants who are lacking bacterial diversity.