Efficacy of Fecal Microbiota Transplant in the Treatment of Severe Alcoholic Hepatitis Compared to Standard of Care in Humans: A Systematic Review

Severe alcoholic hepatitis (SAH) is a life-threatening condition with limited treatment options. Fecal microbiota transplant (FMT) has emerged as a potential therapeutic approach, targeting the imbalance in the gut microbiota observed in SAH patients. This review aims to assess the efficacy of FMT in improving outcomes and compare it with the standard of care in SAH. A systematic review of five multi-patient studies conducted in India was performed. Out of these studies, four were conducted as clinical trials, whereas one was a retrospective observational study design. The primary outcome assessed was survival rates at various time points, including day 28, day 90, and one year. Secondary outcomes included the resolution of complications such as hepatic encephalopathy, ascites, and infections.

Analysis of the studies revealed a significant improvement in survival rates among SAH patients who underwent FMT compared to the standard of care. FMT also demonstrated a reduction in the incidence of complications, including hepatic encephalopathy, ascites, and infections. Additionally, FMT has been associated with positive changes in gut microbiota diversity and a decrease in the colonization of pathogenic taxa. However, the review identified several limitations, including the small sample sizes and the lack of randomized controlled trials. Further research, including conducting larger clinical trials, is necessary to strengthen the evidence for the efficacy of FMT in treating SAH. Additionally, future studies should explore the long-term effects of FMT, its impact on inflammatory cytokine levels, and the potential for personalized approaches based on individual gut microbiota profiles.

In conclusion, this review provides evidence supporting the potential benefits of FMT in the management of severe alcoholic hepatitis. FMT represents a promising alternative to the standard of care and holds promise as a cost-effective treatment modality for eligible SAH patients. Future research should address the identified limitations and explore the optimal implementation of FMT in clinical practice.