The current standard of care for severe alcoholic hepatitis (SAH) comes with several limitations. Additionally, only up to one-third of patients qualify for steroid therapy. Furthermore, the use of steroids itself is associated with numerous concerns like: a non-responding subset of patients, dubious long-term benefit in responding patients and ineligibility to receive steroids entirely in a major group of population and thus the individuals are left with no standard options for treatment. There exists a large gap between the problem and the available solutions. 

Alcohol leads to dysbiosis and disruption of the gut barrier function, thus facilitating the translocation of microbial lipopolysaccharide into the portal circulation and liver. Thus, probiotics, prebiotics, antibiotics, or transplantation of gut microbiota may potentially weaken the dysbiosis-related liver insult. 

Fecal microbiota transplantation (FMT) may manage alcoholic liver disease in general and SAH in particular by revamping dysbiosis, the primary insult. Mouse models have shown alcohol-related liver injury to be transferrable and treatable by adopting FMT from suitable donors. 

Initial human trials have documented benefits in subjects with SAH by improving both disease severity and the rate of survival. Further studies comparing steroids and FMT head-to-hear are underway. Available preliminary data are promising and FMT and/or gut microbial modulation might become the standard of care soon for managing alcohol-related liver diseases, particularly alcoholic hepatitis, with grander applicability, enhanced acceptability, and minimal side effects.

Source- Shasthry SM. Fecal microbiota transplantation in alcohol related liver diseases. Clin Mol Hepatol. 2020;26(3):294-301. doi:10.3350/cmh.2020.0057