In this interview, Giovanni Marasco from University of Bologna, discusses the growing evidence that links gut microbiota dysbiosis to the pathophysiology, clinical prognosis, disease progression, and treatment response of patients with inflammatory bowel disease (IBD). In the interview, the role of microbiota modulation in IBD management is discussed, starting from preventive strategies in at-risk individuals, such as avoiding unnecessary exposure to antibiotics and proton pump inhibitors, which may worsen dysbiosis.

For patients already diagnosed with IBD, diet represents a key first-line approach. In particular, the Mediterranean diet appears to exert anti-inflammatory effects and to promote the activity of bacteria involved in the production of short-chain fatty acids. The interview also reviews the use of selected probiotics in specific clinical settings, including Escherichia coli Nissle in ulcerative colitis and multi-strain probiotic blends in pouchitis, in line with available guideline recommendations.

Finally, the discussion focuses on fecal microbiota transplantation (FMT), which has shown promising signals in mild ulcerative colitis, while its efficacy in pouchitis remains less convincing. Given the heterogeneity of existing studies in terms of delivery methods, number of infusions, and donor selection, experts from Gemelli Hospital, including Franco Scaldaferri and Loris Lopetuso, have promoted consensus initiatives to design an optimal multicenter trial for mild ulcerative colitis. The results of this future study may help clarify the role of FMT in the therapeutic landscape of IBD.