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Preliminary experience with single fecal microbiota transplant for treatment of recurrent overt hepatic encephalopathy—A case series

  • Rajiv Mehta
  • Mayank Kabrawala
  • Subhash Nandwani
  • Parika Kalra
  • Chintan Patel
  • Pankaj Desai
  • Krishna Parekh
Case Series

Abstract

Experimental studies demonstrated that fecal microbiota transplant (FMT) may reverse intestinal microbial dysbiosis. In this retrospective case series, we share our experience of treating recurrent overt hepatic encephalopathy (HE) with single FMT treatment. A total of 10 patients, age ranged from 25 to 65 years, were treated with single FMT through colonoscopy using fecal material received from rigorously screened patient-identified donors. There was sustained clinical response with single FMT treatment in 6 patients at post-treatment week 20. Arterial ammonia concentration decreased considerably (96 [87.25–117.75] vs. 74 [70–82]; p = 0.024) at post-treatment week 20. Moreover, there was statistically significant decrease in Child-Turcotte-Pugh (CTP) score (9.5 [9–10.75] vs. 8 [7–8]; p = 0.005) and model for end-stage liver disease (MELD) score (18 [16.25–19] vs. 15 [14–16]; p = 0.008). Four patients experienced six adverse-events. Overt HE and re-hospitalization were observed in 3 and 2 patients, respectively. One patient (who also experienced overt HE) died within 2 months of the index procedure.

Keywords

Cirrhosis Dysbiosis Fecal microbiota transplant Hepatic encephalopathy 

Notes

Compliance with ethical standards

Conflict of interest

RM, MK, SN, PK, CP, PD, and KP declare that they have no conflict of interest.

Ethical clearance

The authors declare that the study was performed in a manner conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Disclaimer

The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/findings and content of this article.

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Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  • Rajiv Mehta
    • 1
  • Mayank Kabrawala
    • 1
  • Subhash Nandwani
    • 1
  • Parika Kalra
    • 1
  • Chintan Patel
    • 1
  • Pankaj Desai
    • 2
  • Krishna Parekh
    • 3
  1. 1.Department of GastroenterologySurat Institute of Digestive Sciences Majura Gate, Ring Road, Surat 395 002India
  2. 2.Department of GI-EndoscopySurat Institute of Digestive Sciences Majura Gate, Ring Road, Surat 395 002India
  3. 3.Department of Clinical ResearchSurat Institute of Digestive Sciences Majura Gate, Ring Road, Surat 395 002India

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