There are a multitude of limitations to the current standard of care for severe alcoholic hepatitis (SAH) as only up to one-third of the patients can be given steroid therapy. Steroid therapy also has certain limitations. Some patients do not respond to treatment, while the long-term benefit is dubious among those who do respond. A large number of patients are not eligible to receive steroids and do not have any definite treatment options.

Alcohol is known to result in dysbiosis and causes disruption of the gut barrier function, thus contributing to the translocation of microbial lipopolysaccharide into the portal circulation and liver.

Probiotics, prebiotics, antibiotics, or transplantation of gut microbiota could possibly play a role in mitigating dysbiosis-related liver insult. It is expected that fecal microbiota transplantation (FMT) could have a promising role in managing alcoholic liver disease in general, and SAH, in particular by rectifying the dysbiosis.

Animal studies have strongly indicated that alcohol-related liver injury can be treated with FMT from suitable donors. Initial human trials also assert the benefits of FMT in humans with SAH, with improvements noted in disease severity as well as the rate of survival.

The preliminary data show promising results with FMT and/or gut microbial modulation expected to become the standard of care in the foreseeable future for the management of alcohol-related liver diseases, particularly alcoholic hepatitis.

Source: Shasthry SM. Fecal microbiota transplantation in alcohol related liver diseases. Clin Mol Hepatol. 2020 Jul;26(3):294-301.