Chronic alcohol consumption is associated with an increased intestinal permeability and alterations in the intestinal microbiota. This potentially leads to the development and progression of alcohol‐related liver disease. Data is scarce about commensal fungi in the gut.

Lang and colleagues explored the intestinal mycobiota in a cohort of patients with alcoholic hepatitis, alcohol use disorder, and nonalcoholic controls. They also assessed serum anti–Saccharomyces cerevisiae antibodies (ASCA) as a systemic immune response to fungal products or fungi.

Among alcoholic hepatitis and alcohol use disorder patients, Candida appeared to be the most abundant genus in the fecal mycobiota. Genus Penicillium was the most abundant genus in the mycobiome of control subjects. The diversity was lower in the alcohol groups compared to controls. Lower diversity was not tied to antibiotic or steroid treatment. Patients with alcoholic hepatitis were shown to have significantly higher ASCA levels when compared to those with alcohol use disorder and to controls. Within the alcoholic hepatitis patients, those with levels of at least 34 IU/mL had a 90‐day survival of 59% compared to 80% among those with ASCA levels less than 34 IU/mL, with an adjusted hazard ratio of 3.13.

A lower fungal diversity is seen in patients with alcohol‐associated liver disease, with an abundance of Candida, compared with controls. Additionally, there seems to be a link between higher serum ASCA and increased mortality in patients with alcoholic hepatitis.

Intestinal fungi could be a potential therapeutic target for improving survival while ASCA may serve as a useful predictor of the outcome in patients with alcoholic hepatitis.

Source: Lang S, Duan Y, Liu J, et al.Intestinal Fungal Dysbiosis and Systemic Immune Response to Fungi in Patients With Alcoholic Hepatitis. Hepatology 2020;71(2):522-38.