Arif Taha Bin, Damianos John A, Rahman Asad-Ur-, Hasnain Nimra
Department of Internal Medicine, Sinai Hospital of Baltimore, The George Washington University Regional Medical Campus, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Curr Gastroenterol Rep. 2025 Jul 9;27(1):50. doi: 10.1007/s11894-025-01001-6.
Dysbiosis can disrupt intestinal barrier integrity and impact the immune and nervous systems, playing a significant role in developing disorders of gut-brain interaction (DGBI). This review aims to provide a comprehensive understanding of dysbiosis and its role in DGBI while examining the latest advancements in fecal microbiota transplantation (FMT). It also highlights key challenges in the field and outlines critical directions for future research to optimize FMT strategies, ultimately improving patient outcomes in this evolving treatment area.
In DGBI, dysbiosis triggers immune responses, increases gut permeability, and disrupts nervous system signaling, with contributing factors including diet, antibiotics, stress, and infections. Individuals with DGBI exhibit distinct microbial imbalances, such as an increased Firmicutes-to-Bacteroidetes ratio and reduced beneficial bacteria. FMT has shown mixed results, with factors like patient selection, treatment protocols, and microbiome diversity influencing outcomes. While FMT can improve symptoms in refractory irritable bowel syndrome (IBS), effects may fade over time, requiring repeat treatments. Future FMT approaches should focus on targeted microbial interventions, considering the role of archaea, fungi, and microbial metabolites, while prioritizing optimal donor selection and large-scale trials for long-term efficacy. Despite the promising findings, FMT has not yet been widely endorsed in clinical guidelines due to the variability and heterogeneity of the data available. While much of the research has focused on IBS, studies have also explored the impact of FMT on other conditions such as functional diarrhea, functional constipation, and functional dyspepsia, which all exhibit altered microbial profiles.
肠道菌群失调可破坏肠道屏障完整性，并影响免疫和神经系统，在肠道-脑相互作用障碍（DGBI）的发生发展中起重要作用。本综述旨在全面了解肠道菌群失调及其在DGBI中的作用，同时探讨粪便微生物群移植（FMT）的最新进展。它还强调了该领域的关键挑战，并概述了未来研究的关键方向，以优化FMT策略，最终改善这一不断发展的治疗领域的患者预后。
在DGBI中，肠道菌群失调引发免疫反应，增加肠道通透性，并破坏神经系统信号传导，其促成因素包括饮食、抗生素、压力和感染。患有DGBI的个体表现出明显的微生物失衡，如厚壁菌门与拟杆菌门的比例增加以及有益细菌减少。FMT的结果不一，患者选择、治疗方案和微生物组多样性等因素会影响治疗效果。虽然FMT可改善难治性肠易激综合征（IBS）的症状，但效果可能会随着时间推移而消退，需要重复治疗。未来的FMT方法应侧重于靶向微生物干预，考虑古菌、真菌和微生物代谢产物的作用，同时优先选择最佳供体并进行大规模试验以评估长期疗效。尽管有这些有前景的发现，但由于现有数据的变异性和异质性，FMT尚未在临床指南中得到广泛认可。虽然大部分研究都集中在IBS上，但也有研究探讨了FMT对其他疾病的影响，如功能性腹泻、功能性便秘和功能性消化不良，这些疾病都表现出微生物谱的改变。
