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Corticosteroids, nutrition, pentoxifylline, or fecal microbiota transplantation for severe alcoholic hepatitis

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Abstract

Introduction

Alcohol-induced intestinal dysbiosis is central to the development of the severe alcoholic liver disease. We present the first study to compare outcomes in patients of severe alcoholic hepatitis (SAH) on nutritional therapy, corticosteroids, pentoxifylline, and healthy donor fecal transplantation (FMT) and discuss distinct microbial community and microbiome metabolic functional changes after FMT.

Methods

Out of 1271 liver disease patients, 809 (63.7%) were diagnosed to have the alcoholic liver disease, of which 51 patients (8 treated with corticosteroids, 17 with nutritional support only, 10 with pentoxifylline, 16 receiving FMT) were included. Clinical, biochemical parameters, liver disease, and alcoholic hepatitis severity scores at baseline and mortality at the end of 1 and 3 months were analyzed between groups. Stool microbiota (SM) analysis was performed for healthy controls (HC) and respective recipients after FMT.

Results

All the patients were male. The proportions of patients surviving at the end of 1 and 3 months in the steroids, nutrition, pentoxifylline, and FMT group were 63%, 47%, 40% and 75% [p = 0.179] and 38%, 29%, 30%, and 75% [p = 0.036], respectively. When compared with FMT, relative risk and hazard ratios for death were higher in all the other groups. Following FMT, distinct and beneficial modulation of SM and pathways of dysregulated metabolism, infections, inflammation, and oxidative stress in SAH patients were noted in tandem with improved clinical outcomes.

Conclusions

Healthy donor FMT for SAH improves survival beyond what is offered by current therapies and can function as a cost-effective bridge to liver transplant (LT) or for improving transplant-free survival. Larger studies and randomized trials are unmet needs.

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Authors and Affiliations

  1. The Liver Unit, Cochin Gastroenterology Group, Ernakulam Medical Centre, National Highway Bypass (NH-66), Palarivattom, Kochi, 682 028, India

    Cyriac Abby Philips

  2. Molecular, Cellular and Developmental Biology, Genepath-Dx, 1260, Jangali Maharaj Road, Shivajinagar, Pune, 411 004, India

    Nikhil Phadke & Shatakshi Ranade

  3. Helical Bío, Ann Arbor, Michigan, United States of America

    Karthik Ganesan

  4. Gastroenterology, Cochin Gastroenterology Group, Ernakulam Medical Centre, National Highway Bypass (NH-66), Palarivattom, Kochi, 682 028, India

    Philip Augustine

Authors
  1. Cyriac Abby Philips
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  2. Nikhil Phadke
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  4. Shatakshi Ranade
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  5. Philip Augustine
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Correspondence to Cyriac Abby Philips.

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Conflict of interest

CAP, NP, KG, SR, and PA declare that they have no conflict of interest.

Ethics statement

All procedures performed in studies involving human participants were by the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Philips, C.A., Phadke, N., Ganesan, K. et al. Corticosteroids, nutrition, pentoxifylline, or fecal microbiota transplantation for severe alcoholic hepatitis. Indian J Gastroenterol 37, 215–225 (2018). https://doi.org/10.1007/s12664-018-0859-4

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  • DOI: https://doi.org/10.1007/s12664-018-0859-4

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