Fecal Microbiota Therapy in Steroid Ineligible Alcoholic Hepatitis
Status:
Not yet recruiting
Trial end date:
2024-03-31
Target enrollment:
Participant gender:
Summary
Alcoholic hepatitis, the most florid form of alcoholic liver disease, has a very high
short-term mortality of up to 50% and no specific therapies are available other than
steroids. Steroids also only show a limited utility in improving the short-term survival and
boast no evidence of any long-term benefits. Additionally, only a small proportion of
patients with alcoholic hepatitis are eligible to receive steroids. Thus, a large number of
patients are either not eligible or do not respond to steroids and this group outnumbers
those who do respond to steroids, leaving us without any specific therapeutic options for a
majority of these individuals.Even liver transplantation is not feasible in most cases due to
the presence of sepsis or recent alcohol consumption and many ethical and logistic issues are
involved despite the documented safety and survival benefits of early liver transplantation
in patients with severe alcoholic hepatitis (SAH) not responding to medical
management.Therefore, newer, more effective, and nontransplant therapeutic options for
managing severe alcoholic hepatitis are needed. Since gut dysbiosis, leaky gut, and products
of the gut microbiome reaching the liver are the main culprits in the development of
alcoholic hepatitis, targeting qualitative and quantitative changes in the gut microbiome
remains an important strategy in developing new therapies for alcoholic hepatitis. Among
others, the modulation of gut microbiota by fecal microbiota transplantation (FMT) has
recently been conceptualized and evaluated as a potential therapeutic strategy in both
preclinical and clinical studies.