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

Mehta, Rajiv; Kabrawala, Mayank; Nandwani, Subhash; Kalra, Parika; Patel, Chintan; Desai, Pankaj; Parekh, Krishna

doi:10.1007/s12664-018-0906-1

Cited by 35 publications

(30 citation statements)

References 11 publications

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“…8 On the contrary, Mehta et al have shown signi cant improvement in both CTP and MELD scores between baseline and week 20 [P=0.005; P= 0.008, respectively]. 9 However, this latter study had an intrinsic limitation of not having a comparative control group. The differences between these studies possibly re ect differences in the baseline MELD scores.…”

Section: Discussionmentioning

confidence: 93%

“…7 Initial experience from a few small studies indicates that FMT improves neurocognitive scores and reduces breakthrough HE episodes by altering GM and reducing SI. 8,9,10 However, these studies have speci cally focused only on the subgroup of patients with HE. Hence, in this randomized, open-labeled trial, we aimed to determine whether FMT administration in the setting of DC leads to a reduction in systemic in ammation, improvement of prognostic scores, reduction of complications, and its impact on overall survival.…”

Section: Introductionmentioning

confidence: 99%

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Single Session of Fecal Microbiota Transplantation in Decompensated Cirrhosis: An open-label randomized control trial

Roy¹,

Premkumar²,

Sharma³

et al. 2021

Preprint

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Background: Modulation of gut dysbiosis with Fecal Microbiota Transplantation (FMT) is a novel modality and has shown promising results in decompensated cirrhosis (DC). We explored the impact of FMT on prognostic scores, complications, ammonia levels, inflammatory markers [(Interleukin -1 (IL-1) and 6 (IL-6)], and 180-day mortality in DC.Methods: Consecutive patients with DC (MELD12-21) were assigned to either FMT (FMT group) delivered as 30gm freshly prepared stool (from a related stool donor) homogenized in 100 ml of normal saline through a nasojejunal tube or standard of care therapy (SOC group). Outcomes were assessed on days 7, 28, 90, and 180.Results: Eighteen patients each with comparable baseline characteristics (88.8% males; mean age, 46.12±6.23 vs. 47.0±4.54; mean CTP, 9.5±0.71 vs. 9.6±0.80; mean MELD, 16.1±1.71 vs. 1.62±1.81) were allocated to FMT or SOC. Although significant differences were noted in the CTP score on day 7 (P=0.02) and day 90 (P=0.01), MELD and MELD-Na scores were similar at all time points. A non-significant reduction in ammonia levels was seen on day 7 and day 28 (P=0.21 and P=0.17; respectively). IL-1 (P=0.01) and IL 6 (P=0.005) levels reduced significantly on day 28. New-onset variceal bleed (P=0.70), breakthrough hepatic encephalopathy events (P=0.61) and 180-day survival (HR, 2.02; 95% CI, 0.37-11.05; P=0.41). were similar. Although transient gastrointestinal side-effects were common (56.2%), no serious adverse events were noted.Conclusion: Single session FMT in DC is safe and leads to selective improvement of CTP scores and systemic inflammatory markers but offers no survival benefit. (ClinicalTrials.gov number, NCT04842539)

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Single Session of Fecal Microbiota Transplantation in Decompensated Cirrhosis: An open-label randomized control trial

Roy¹,

Premkumar²,

Sharma³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…8), and MELD score (18!15) at 20 weeks post-FMT; however, one patient died within 2 months after the procedure. 70 Another method of FMT administration via oral capsules was trialed. 71 A one-time dose of 15 FMT capsules from a donor enriched in Lachnospiraceae and Ruminococcaceae was well-tolerated in 10 patients with cirrhosis and recurrent HE, and resulted in improved duodenal mucosal diversity, dysbiosis, and antimicrobial peptide expression, reduced LPS-binding protein (LBP), and improved cognitive performance.…”

Section: Fecal Microbiota Transplantationmentioning

confidence: 99%

New Developments in Microbiome in Alcohol-Associated and Nonalcoholic Fatty Liver Disease

Hartmann

Schnabl

2021

Semin Liver Dis

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Alcohol-associated liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD) are important causes of morbidity and mortality worldwide. The intestinal microbiota is involved in the development and progression of both ALD and NAFLD. Here we describe associated changes in the intestinal microbiota, and we detail randomized clinical trials in ALD and NAFLD which evaluate treatments modulating the intestinal microbiome including fecal microbiota transplantation, probiotics, prebiotics, synbiotics, and antibiotics. Finally, we discuss precision medicine approaches targeting the intestinal microbiome to ameliorate ALD and NAFLD.

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“…Fecal microbiota transplant was also reported to have beneficial outcomes reversing the intestinal microbial dysbiosis [13]. Additionally, probiotics have been used as secondary prophylaxis of HE, either as natural probiotics or in a pharmaceutical dosage form [14,15].…”

Section: Fecal Transplant and Probioticsmentioning

confidence: 99%

Pharmacotherapy of Hepatic Encephalopathy

Al-Muhaideb¹,

Ajlan²

2019

Liver Cirrhosis - Debates and Current Challenges

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Hepatic encephalopathy (HE) or portosystemic encephalopathy (PSE) is a serious neuropsychiatric disorder resulting from liver failure. It is one of the common complications of liver cirrhosis and portosystemic shunting (PSS). Ammonia accumulation is one of the well-established causes. Ammonia is a by-product of the intestinal bacteria as a result of the breakdown of dietary supplements. In the normal state of the liver, the peripheral hepatocyte contains glutaminase that converts glutamine into glutamate and ammonia; ammonia will be detoxified and converted into urea. The variant manifestations were linked to the severity of HE. A wide range of neurological and psychiatric signs have been reported. The International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) uses asterixis (i.e., flapping tremor) as the first clinical sign of HE. Four factors should be taken into consideration to classify and distinguish HE from other conditions: HE type, severity of manifestations following West-Haven Criteria (WHC), HE time course, and presence of precipitating factors. Nonabsorbable disaccharides (lactulose and lactitol) and rifaximin have been the standard of care as first-and second-line therapies, respectively. Non-pharmacological interventions had a crucial role in HE management. Liver transplantation is the ultimate management of hepatic cirrhosis.

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

Cited by 35 publications

References 11 publications

Single Session of Fecal Microbiota Transplantation in Decompensated Cirrhosis: An open-label randomized control trial

Single Session of Fecal Microbiota Transplantation in Decompensated Cirrhosis: An open-label randomized control trial

New Developments in Microbiome in Alcohol-Associated and Nonalcoholic Fatty Liver Disease

Pharmacotherapy of Hepatic Encephalopathy

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