System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Review Ppublish 12 citations

PubMed: 38313244 DOI: 10.4254/wjh.v16.i1.17

Role of fecal microbiota transplant in management of hepatic encephalopathy: Current trends and future directions.

World J Hepatol 16(1):17-32

Authors: Yash R Shah, Hassam Ali, Angad Tiwari, David Guevara-Lazo, Natalia Nombera-Aznaran, Bhanu Siva Mohan Pinnam, Manesh Kumar Gangwani, Harishankar Gopakumar, Amir H Sohail, SriLakshmiDevi Kanumilli, Ernesto Calderon-Martinez, Geetha Krishnamoorthy, Nimish Thakral, Dushyant Singh Dahiya

Affiliations

  • Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, United States.
  • Division of Gastroenterology and Hepatology, East Carolina University/Brody School of Medicine, Greenville, NC 27858, United States.
  • Department of Internal Medicine, Maharani Laxmi Bai Medical College, Jhansi 284001, India.
  • Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru.
  • Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States.
  • Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States.
  • Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, United States.
  • Department of Surgery, University of New Mexico, Albuquerque, NM 87106, United States.
  • Department of Internal Medicine, GSL Medical College, Rajamahendravaram 533296, India.
  • Department of Internal Medicine, Universidad Nacional Autonoma de Mexico, Ciudad De Mexico 04510, Mexico.
  • Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, KY 40536, United States.
  • Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States.

Abstract

Fecal microbiota transplantation (FMT) offers a potential treatment avenue for hepatic encephalopathy (HE) by leveraging beneficial bacterial displacement to restore a balanced gut microbiome. The prevalence of HE varies with liver disease severity and comorbidities. HE pathogenesis involves ammonia toxicity, gut-brain communication disruption, and inflammation. FMT aims to restore gut microbiota balance, addressing these factors. FMT's efficacy has been explored in various conditions, including HE. Studies suggest that FMT can modulate gut microbiota, reduce ammonia levels, and alleviate inflammation. FMT has shown promise in alcohol-associated, hepatitis B and C-associated, and non-alcoholic fatty liver disease. Benefits include improved liver function, cognitive function, and the slowing of disease progression. However, larger, controlled studies are needed to validate its effectiveness in these contexts. Studies have shown cognitive improvements through FMT, with potential benefits in cirrhotic patients. Notably, trials have demonstrated reduced serious adverse events and cognitive enhancements in FMT arms compared to the standard of care. Although evidence is promising, challenges remain: Limited patient numbers, varied dosages, administration routes, and donor profiles. Further large-scale, controlled trials are essential to establish standardized guidelines and ensure FMT's clinical applications and efficacy. While FMT holds potential for HE management, ongoing research is needed to address these challenges, optimize protocols, and expand its availability as a therapeutic option for diverse hepatic conditions.

MeSH

Brain Diseases, Liver Diseases, Therapeutics, Hepatic Encephalopathy, Transplants, Gastrointestinal Microbiome, Fecal Microbiota Transplantation, Non-Alcoholic Fatty Liver Disease

Cited by