Fecal Transplant Shows Promise for Treating Inflammatory Bowel Disease

People with inflammatory bowel disease (IBD) who can’t achieve remission with targeted drugs might one day be able to get their symptoms under control by adding so-called microbiota therapeutics like fecal transplants to their treatment regimen, a new study suggests.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291aaa68f2-459d-45cf-a0c9-03d3e075c2d3 For the study, scientists reviewed results from 15 clinical trials that tested fecal microbiota transplants (FMT) — when stool with healthy microorganisms is inserted into a sick patient’s digestive tract — in people with ulcerative colitis, Crohn’s disease, and Clostridioides difficile , or C. difficile infections. “Microbiota therapeutics use the microbes that are found in the gut of healthy people as a drug to treat a disease or condition,” says study coauthor Ari Grinspan, MD, an associate professor and director of the FMT program at the Icahn School of Medicine at Mount Sinai in New York City. “They are essentially the ultimate probiotic.” While FMT is still only an experimental intervention for ulcerative colitis and Crohn’s disease, results from the early-stage tests reviewed for the study suggest that this approach holds promise, Dr. Grinspan says. That’s because people with IBD typically have a gut microbiome — the mix of bacteria, fungi, parasites, and viruses in our digestive tract — that lacks a necessary blend of healthy organisms. Microbiota therapeutics like FMT are thought to ease IBD symptoms by increasing the population of healthy organisms in the digestive tract, Grinspan says. “They drastically increase the richness and diversity of the microbiota in the human colon and bring back the normal function of the gut microbiome,” Grinspan adds. FDA-Approved FMT Medications So far, the U.S. Food and Drug Administration (FDA) has approved two FMT medications — Rebyota and Vowst — to prevent recurrent C. difficile infections. These infections involve what’s known as dysbiosis, or a lack of normal diversity of organisms in the gut microbiome, Grinspan says. “Inflammatory bowel disease is also characterized by dysbiosis in the gut microbiome,” Grinspan says. “So, the theory is that if we can restore the normal healthy diversity and richness of the gut microbiome in patients with IBD, then maybe we can help treat the disease.” In five early-stage trials testing FMT in more than 300 people with mild-to-moderate ulcerative colitis, this intervention achieved symptom remission in about 30 percent of participants, compared with roughly 10 percent in the placebo group, the new study found. “Several FMT trials have demonstrated benefits for patients with mild-to-moderate ulcerative colitis, with some patients achieving steroid-free remission,” says Iliyan Iliev, PhD, an associate professor of microbiology and co-director of the microbiome core laboratory at Weill Cornell Medicine in New York City. Many patients with ulcerative colitis can’t achieve remission without continuing to take steroids to manage their symptoms, says Dr. Iliev, who wasn’t involved in the new study. Earlier trials of FMT also suggest that this approach may work best when patients receive a course of antibiotics before treatment, according to the new study.
Early Trials for IBD Testing to date also suggests that initial FMT interventions may work best by using an endoscopy — a nonsurgical procedure that sends a tube down the throat to the digestive tract. For IBD patients, additional courses of FMT may be needed to maintain remission, and it may be possible to use FMT capsules in these situations, the study concludes. Less is known at this point about FMT in Crohn’s disease patients, but the study did examine two early-stage trials with 44 patients. Two-thirds of patients in one study and 87 percent of participants in the other study achieved remission with FMT. One limitation of the new study is that scientists still lack data on the optimal ways to combine FMT with targeted drugs that are the current standard of care for IBD. People with severe IBD are often treated with targeted biologic therapies like infliximab (Remicade), adalimumab (Humira), or ustekinumab (Stelara). “The existing treatments cannot keep all patients in remission, therefore, microbiota therapeutics are needed,” says Jun Sun, PhD, a professor and IBD researcher at the University of Illinois in Chicago, who wasn’t involved in the new study. “It is still unknown if the combination of biologics and microbiota treatment is best for patients with IBD,” Dr. Sun says. Trials for C. Difficile Infections A review of 26 studies of FMT for C. difficile infections found oral capsules worked as well as a more invasive approach — a colonoscopy — for administering FMT to prevent repeat infections, according to the new study. One challenge with FMT is that it requires stool from healthy donors to formulate treatments, the study authors point out. Another challenge is that scientists are still not certain of the precise FMT dose necessary to help IBD patients achieve remission. “FMT is inherently crude, complex, and challenging to standardize,” Iliev says. But continued efforts to research FMT for ulcerative colitis and Crohn’s disease stand a good chance of success based on the results seen with C. difficile infections, Grinspan says. And it’s worth the effort because current treatments for IBD leave a lot to be desired and there’s been little improvement in treatment options over the last decade, Grinspan adds. FMT Has ‘Great Potential’ for IBD “The use of microbiota therapeutics holds great potential for achieving remission in patients with IBD,” Grinspan says. Right now, ulcerative colitis and Crohn’s disease patients can only get FMT interventions through clinical trials, Grinspan notes. Studies like this can be hard to access, especially for people who live outside of major metropolitan areas where most medical research takes place. And even when patients join trials, there’s still a good chance of receiving a placebo instead of FMT. Even though trials done so far look promising, the outcome isn’t guaranteed, Grinspan cautions. “FMT for IBD is not ready for prime time,” Grinspan says. “I am optimistic that we will find the right population that will benefit from microbial therapeutics — but we have a lot more to learn.”

Are you and your partner neglecting sex play? Learn how to add it back into your routine to boost your bond in and out of the bedroom. While "quickies" can be fun and spontaneous, skipping foreplay means missing out on a great way to connect emotionally and physically. According to Pepper Schwartz, PhD, a sexual health expert and researcher at the University of Minnesota in Minneapolis, foreplay is critical, elemental, and necessary. Foreplay, also known as "outercourse," is any sexual activity that occurs before intercourse. There is no single way to engage in foreplay, as it can mean different things to different people. It can involve kissing, caressing, cuddling, flirty texting or talking, massage, and oral sex. If you like it a little rough, biting, pinching, scratching, and spanking can be a turn-on. The goal is to increase sexual excitement, which can help prepare the body for intercourse. Foreplay is sometimes thought of as a warm-up for sex, but it doesn't necessarily have to lead to intercourse. Some couples find foreplay itself to be sexually fulfilling as a main event. The benefits of foreplay include lubrication of the vagina, an extended erection, and the prevention of premature ejaculation for people with penises. The female body pulls the uterus up when aroused, lengthening the vagina. This process, called uterine tenting, creates a pool area for semen, which is part of the reproductive sophistication of our machinery, according to Dr. Schwartz. As those muscles relax, the nerve endings start to get stimulated, paving the way for a more pleasurable experience. Research involving married couples has found that 1 to 10 minutes of foreplay was associated with 40% of women achieving orgasm during sex. That percentage rose to 50 with 12 to 20 minutes of foreplay and 60 with more than 20 minutes of foreplay. If you want more action in bed, you have to let your partner know what you want. But talking about sex can be easier said than done for some. Dr. Lyndsey Harper, a clinical assistant professor of obstetrics and gynecology at Texas A&M School of Medicine in Bryan, Texas, recommends two sentence starters to try when expressing sexual desire to your partner: "I want you to..." and "It feels so good when you...". If it makes you more comfortable, you can bring up your sexual needs outside of the bedroom. If you don't know how to bring it up, she suggests starting the conversation with something like, "Our sex life is really important, and I'd love for us to feel open talking about things. Would it be okay for me to share with you some things I like?" Communication comfort is closely linked to trust. To experience true intimacy and fun foreplay, trusting each other is essential, especially since our needs constantly change. Couples who find it difficult to communicate about their desires should consider seeing a couple's counselor or sex therapist who can help them navigate these discussions.
  • Foreplay is just play. Couples can engage in it however they want. According to Dr. Harper, it generally takes about 20 minutes of arousal for women to become fully lubricated and ready for penetrative sex. However, it is best to abolish the idea of "foreplay" and the "main event" of penetrative sex and work together with your partner to create a fun and intimate sexual life where everyone's needs are met.

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