The role of the intestinal microbiome in alcoholic hepatitis is not clearly understood. Smirnova and colleagues carried out a study to outline the fecal microbial ecology associated with alcoholic hepatitis, link microbiome changes to disease severity, and to surmise the functional significance of alterations in microbial ecology.

Investigators compared the fecal microbiome in patients with moderate alcoholic hepatitis (MAH) or severe alcoholic hepatitis (SAH), healthy controls (HCs) and heavy drinking controls (HDCs).

The study involved 78 participants – 24 HCs, 20 HDCs, 10 with MAH, and 24 with SAH. HDCs were found to have a distinct signature when compared with HCs with evidence of depletion of Bacteroidetes (46% vs. 26%). Those with alcoholic hepatitis had a distinct microbiome signature in comparison with HDCs. This included differential abundance of Ruminococcaceae, Veillonellaceae, Lachnospiraceae, Porphyromonadaceae, and Rikenellaceae families. Beta diversity varied significantly among the groups. Patients with SAH had increased Proteobacteria (SAH 14% vs. HDC 7% and SAH vs. HC 2%). The abundance of Firmicutes was found to reduce from HDC to MAH to SAH (63% vs. 53% vs. 48%). Microbial taxa were found not to differentiate MAH from SAH. SCFAs producing bacteria (Lachnospiraceae and Ruminococcaceae) were reduced in alcoholic hepatitis with a similar reduction seen in fecal SCFAs among alcoholic hepatitis patients.

Fecal microbiome shows distinct changes in association with the development of alcoholic hepatitis but not with severity.

Source: Smirnova E, Puri P, Muthiah MD, et al.Fecal Microbiome Distinguishes Alcohol Consumption From Alcoholic Hepatitis But Does Not Discriminate Disease Severity. Hepatology. 2020 Jul;72(1):271-286.