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BMJ Case Reports 2017; doi:10.1136/bcr-2017-222310
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)
  • CASE REPORT

Healthy donor faecal transplant for corticosteroid non-responsive severe alcoholic hepatitis

  1. Philip Augustine4
  1. 1The Liver Unit, Ernakulam Medical Centre, Kochi, Kerala, India
  2. 2Molecular, Cellular and Developmental Biology, Genepath Dx, Pune, Maharashtra, India
  3. 3Biomedical Software and Instrumentation, Helicalbio, Ann Arbor, Michigan, USA
  4. 4Gastroentrology, Ernakulam Medical Centre, Kochi, Kerala, India
  1. Correspondence to Dr Cyriac Abby Philips, abbyphilips{at}gmail.com
  • Accepted 20 October 2017
  • Published 8 November 2017

Summary

Patients with severe alcoholic hepatitis (SAH) have high mortality in the presence of steroid unresponsiveness in the absence of clear treatment recommendations. Liver transplantation is the curative option in such cases but is controversial in the wake of severe infections, post-transplant recidivism and long waiting on deceased donor listing. Animal and human studies have shed light on the beneficial effects of gut microbiota modulation in alcoholic liver disease. We present the first report of faecal microbiota transplantation (FMT) in a steroid non-responder in whom, clinical, biochemical and liver disease severity scores improved post-FMT and demonstrate distinct bacterial population changes pre-FMT and post-FMT. Healthy donor FMT could be safe and efficacious in SAH not responding to corticosteroid treatment, as a bridge to liver transplantation (LT) or in candidates who are unwilling or not ideal for LT for improvement in short-term transplant free survival. Larger controlled studies are required for confirmation.

Footnotes

  • Contributors CAP: study concept and design, acquisition of data, analysis; NP and KG: interpretation of data and analysis; PA: critical revision of the manuscript for important intellectual content; all authors finalised manuscript content.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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