Effectiveness and safety of gut microbiota modification in intestinal diseases. Review

The gut microbiota (GM) is a complex and dynamic community of microorganisms that colonize the human gastrointestinal tract and play an important role in various aspects of the host’s physiology and health. GM is involved in digestion and assimilation of nutrients, synthesis of vitamins and metabolites, modulation of the immune system and defense against pathogens. However, the gut microbiota can also be a source of inflammation and disease when its composition and function are altered. This phenomenon, known as dysbiosis, is associated with almost all gastrointestinal diseases and is most prominent in inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), colorectal cancer, and celiac disease. Considering the important role of GM in the pathogenesis of IBD and other diseases of the gastrointestinal tract, several methods of its modification have been proposed, including the use of probiotics, prebiotics, synbiotics, antibiotics, dietary interventions, fecal microbiota transplantation (FTM) and bacteriophage therapy. However, drawing general conclusions about the efficacy and safety of these approaches is often difficult due to variability in interventions, doses, timing of administration, and the inevitable heterogeneity of host microbiome profiles and gut status. This review presents the results of a large international survey, purposed on the assessment of current practice, preferences, challenges, and expectations of doctors regarding the assessment of the composition of GM and the use of antibiotics, probiotics and TFM in intestinal diseases. The survey was also aimed on the identification of factors influencing the decision‑making process by doctors and barriers limiting the implementation of GM modification in clinical practice. Conclusions drawn from the results of the survey highlight the need for further research, standardization of techniques and evidence‑based recommendations to optimize the use of probiotics, antibiotics and TFM in clinical practice.