A commonly used antifungal medication may help reduce symptoms in a subset of patients with inflammatory bowel disease, according to a preliminary study from Weill Cornell Medicine researchers published Sept. 1 in Nature Medicine.
What the early data showed
The prospective observational IVAN study enrolled 53 patients with mild-to-moderate Crohn’s disease or ulcerative colitis who also had mild oral thrush and were already receiving routine care. Participants received two weeks of either nystatin mouthwash or the systemic antifungal fluconazole, allowing researchers to compare how each approach affected symptoms and the gut microbiome.
Patients who received fluconazole, which acts throughout the gastrointestinal tract, experienced improved IBD symptoms and a healthier gut microbial community after treatment. The study reported increased bacterial diversity, enhanced butyrate production and improved clinical disease activity. By contrast, the locally acting nystatin mouthwash cleared thrush but did not produce the same intestinal changes.
Why the finding matters
Researchers said the results offer what is thought to be the first evidence that targeting intestinal fungal dysbiosis can reshape bacterial and fungal microbiome dynamics in patients with IBD. The work suggests that fungi in the gut may play a role in disease progression for some patients, and that a microbiome-based approach could eventually help guide more precise treatment decisions.
Dr. Iliyan D. Iliev said reducing intestinal Candida burden appeared to restore some beneficial bacteria and microbial metabolites associated with intestinal health, while also improving clinical disease activity. The team also noted that cheek swabs may help identify fungal patterns that mirror the gut, potentially aiding future patient selection.
What comes next
The researchers stressed that the study was not randomized or placebo-controlled and was not designed to prove therapeutic efficacy. Larger, multicenter placebo-controlled trials will be needed to confirm whether antifungal co-therapy can benefit biomarker-selected patients and to determine which IBD subtypes may respond best.
If confirmed, the approach could open a new route for patients with Crohn’s disease and ulcerative colitis, particularly those whose symptoms may be influenced by fungal overgrowth alongside broader microbiome imbalance. For now, the findings add a fresh angle to the search for more personalized treatment strategies in chronic inflammatory bowel disease.
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