Hepatic encephalopathy is a major complication observed in patients with liver disease (cirrhosis) and is characterized by neurological disorders: cognitive disorders, personality changes or confusion. The treatment is based, among others, on the use of antibiotics which progressively alter the gut microbiota at every treatment course. As a result, many relapses occur that eventually cause irreversible damage to the brain.
About this article
The presence of a gut dysbiosis–characterized by reduced levels of beneficial SCFAs-producing bacteria and increased levels of harmful bacteria associated to cognitive disorders–was observed in patients with hepatic encephalopathy. These observations led researchers to consider fecal microbiota transplant as a therapeutic alternative to antibiotics16.
A unique donor
An initial study focused on this indication was conducted on a small cohort of only twenty cirrhotic men, who were administered either the standard treatment, or FMT combined with an antibiotic pretreatment aiming at preparing the recipient’s digestive tube. The fecal microbiota came from one single donor, selected through an AI software based on the abundance in his/her microbial flora of bacteria that are precisely lacking in these patients.
A promising approach
None of the transplant recipients had an additional episode of encephalopathy, while 5 out of the 10 control patients relapsed. A slight increase in lactobacilli and bifidobacteria was also observed in the former, while no change was observed in the latter. Finally, only FMT produced an improvement in cognitive functions which led researchers to advocate for further investigation.
16 Bajaj JS, et al. Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy: A randomized clinical trial. Hepatology. 2017