Acceptability of probiotics, fecal microbiota transplantation, and emerging microbiome-derived therapies in patients with inflammatory bowel diseases: A cross-sectional Survey Study
Nathan Grellier, Clotilde Policar, Safa Hachicha, Samira Denguir, Anne Bourrier, Cecilia Landman, Isabelle Nion-Larmurier, Paul McLellan, Julien Kirchgesner, Harry Sokol, Nicolas Delsuc, Enguerran Macia, Philippe SeksikBackground
Microbiome-derived therapies (MDT), including probiotics and fecal microbiota transplantation (FMT), represent promising therapeutic approaches in inflammatory bowel disease (IBD).
Objectives
We aimed to evaluate patient preferences and determinants of MDT acceptability in IBD.
Design
Single-center cross-sectional survey conducted between April and July 2024.
Methods
Adult patients with IBD completed a structured questionnaire evaluating preferences regarding probiotics, FMT, and modified bacteria (chemically and genetically modified bacteria). Multivariate logistic regression identified factors associated with MDT acceptance.
Results
A total of 324 patients were included (205 Crohn’s disease, 63.3%; median disease duration 15.6 years; 82.4% in remission). Overall, 83.3% of patients accepted at least one MDT, whereas 16.7% rejected all treatments. When choosing between probiotics and FMT, 39.5% preferred probiotics, 37.7% were open to both, 14.2% rejected both, and 4.0% preferred FMT. Across all options, probiotics were the most acceptable (35.5%), followed by chemically modified bacteria (24.1%), while FMT was less frequently chosen (12.7%). Probiotic preference was mainly driven by practicality (21.1%) and perceived efficacy (21.9%). Higher educational level independently predicted MDT acceptance (aOR 1.26 per additional year; 95% CI 1.10–1.45; p<0.001), and moderate-to-severe disease activity predicted acceptance of probiotics and modified bacteria (aOR 2.25; 95% CI 1.09–5.14; p=0.03).
Conclusion
MDT acceptability was high in patients with IBD. Probiotics and modified bacteria were the most acceptable options, whereas FMT remained limited by patient reluctance. Educational level and disease activity were significantly associated with acceptance, underscoring the need to improve patient education on MDT and to integrate patient perspectives early in therapeutic development to ensure the design of acceptable MDT strategies.