Microbiome-Driven Strategies in the Management of Inflammatory Bowel Disease

Abstract:

Inflammatory Bowel Disease (IBD) is a chronic, relapsing inflammatory disorder of the gastrointestinal tract that arises from complex interactions among genetic susceptibility, environmental factors, immune dysregulation, and alterations in the gut microbiota. Increasing evidence has established gut microbial dysbiosis as a key contributor to the pathogenesis of IBD. Dysbiosis is characterized by reduced microbial diversity, depletion of beneficial commensal microorganisms, and expansion of pro-inflammatory pathobionts, leading to impaired intestinal barrier function, aberrant immune activation, and persistent mucosal inflammation. Consequently, the gut microbiome has emerged as a promising therapeutic target, with microbiome-based interventions offering novel opportunities for the prevention, management, and personalized treatment of IBD. This review critically summarizes recent advances in the field of microbiome-targeted therapies, such as probiotics, prebiotics, synbiotics, dietary interventions, and Fecal Microbiota Transplantation (FMT). Recent meta-analyses have reported remission rates of approximately 27–53% in ulcerative colitis patients receiving FMT, depending on protocol and donor selection, postbiotics, bacteriophage therapy, and engineered microbial therapeutics (2020- 2025). Fibre-rich diets, fermented foods, omega-3 fatty acids and polyphenol-rich foods have been shown to positively impact microbial composition, production of short-chain fatty acids and inflammatory signalling pathways. There is currently some evidence of clinical benefits of FMT and certain probiotic formulations for ulcerative colitis, but there is variability in treatment responses. Future innovations such as the development of metagenomics, metabolomics, precision microbiome profiling, etc., will help guide personalized therapeutic interventions. But there are still several hurdles to overcome, such as poor standardization, long-term safety, regulatory hurdles, and variable patient-specific microbiome responses. In summary, microbiome modulation is a promising complementary therapy for IBD and can be a key element in the evolution of precision medicine for the management of chronic intestinal inflammatory diseases.