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World J Gastroenterol. Aug 28, 2016; 22(32): 7186-7202
Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7186
Modulation of microbiota as treatment for intestinal inflammatory disorders: An uptodate
Antonella Gallo, Giovanna Passaro, Antonio Gasbarrini, Raffaele Landolfi, Massimo Montalto
Antonella Gallo, Giovanna Passaro, Raffaele Landolfi, Massimo Montalto, Institute of Internal Medicine, Fondazione Policlinico “Agostino Gemelli”, Catholic University of Sacred Heart, 00168 Rome, Italy
Antonio Gasbarrini, Institute of Internal Medicine, Gastroenterology and Hepatology, Department of Medical Science, Catholic University, 00168 Rome, Italy
Author contributions: Gallo A and Passaro G collected data and wrote the paper together with Montalto M, Gasbarrini A and Landolfi R; all the authors gave final approval of the version of the article to be published.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonella Gallo, MD, Institute of Internal Medicine, Fondazione Policlinico “Agostino Gemelli”, Catholic University of Sacred Heart, Largo A. Gemelli, 8, 00168, Rome, Italy. antonellagallo.1983@gmail.com
Telephone: +39-6-30154334 Fax: +39-6-35502775
Received: March 25, 2016
Peer-review started: March 26, 2016
First decision: May 12, 2016
Revised: June 23, 2016
Accepted: August 1, 2016
Article in press: August 1, 2016
Published online: August 28, 2016
Processing time: 151 Days and 15.5 Hours
Abstract

Alterations of intestinal microflora may significantly contribute to the pathogenesis of different inflammatory and autoimmune disorders. There is emerging interest on the role of selective modulation of microflora in inducing benefits in inflammatory intestinal disorders, by as probiotics, prebiotics, synbiotics, antibiotics, and fecal microbiota transplantation (FMT). To summarize recent evidences on microflora modulation in main intestinal inflammatory disorders, PubMed was searched using terms microbiota, intestinal flora, probiotics, prebiotics, fecal transplantation. More than three hundred articles published up to 2015 were selected and reviewed. Randomized placebo-controlled trials and meta-analysis were firstly included, mainly for probiotics. A meta-analysis was not performed because of the heterogeneity of these studies. Most of relevant data derived from studies on probiotics, reporting some efficacy in ulcerative colitis and in pouchitis, while disappointing results are available for Crohn’s disease. Probiotic supplementation may significantly reduce rates of rotavirus diarrhea. Efficacy of probiotics in NSAID enteropathy and irritable bowel syndrome is still controversial. Finally, FMT has been recently recognized as an efficacious treatment for recurrent Clostridium difficile infection. Modulation of intestinal flora represents a very interesting therapeutic target, although it still deserves some doubts and limitations. Future studies should be encouraged to provide new understanding about its therapeutical role.

Keywords: Microbiota; Inflammation; Gut; Probiotic; Prebiotic

Core tip: Alterations of intestinal microflora may significantly contribute to the pathogenesis of different inflammatory and autoimmune disorders. It is conceivable that selective modulation of intestinal microflora may induce benefits. In this article we tried to summarize recent evidences on microflora modulation in main intestinal inflammatory disorders, providing practical perspectives on its therapeutical role in these conditions.