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Faecal microbiota transplantation benefits those with advanced cirrhosis

Using faecal microbiota transplantation in patients with advanced cirrhosis improves gut flora microbiota and ammonia metabolism, according to a feasibility trial by UK and Swedish researchers.

Data from the prospective, randomised placebo controlled feasibility trial of faecal microbiota transplantation (PROFIT) trial was presented at the European Association for the Study of the Liver (EASL) 2023 congress.

Gut flora and bacterial translocation play an important role in the pathogenesis of the complications of cirrhosis such as hepatic encephalopathy (HE). The antibiotic rifaximin reduces the risk of HE recurrence and HE-related hospitalisations in cirrhosis, possibly through its effects on metabolic function of the gut microbiota and a reduction in ammonia-producing bacteria.

But whether faecal transplantation, by modifying the gut microbiota, could benefit those with cirrhosis is unclear and this was the subject of an abstract (GS-007) presented at the congress. For the study, 50 g of frozen faecal microbiota transplants (FMT) were administered into the jejunum via endoscopy in a ratio of 3:1 (FMT vs placebo). The study was single-blind, so only the investigators were aware of the intervention received by patients. Blood and stool samples were collected at baseline and then after seven, 30 and 90 days.

Faecal transplantation in advanced cirrhosis

A total of 32 patients were included in the study. FMT significantly reduced the stool carriage of Enterococcus faecalis and other pathobionts. There was also a significant reduction after 30 days in plasma ammonia (p = 0.0006), with a corresponding higher faecal ammonia (p = 0.011) in the FMT group compared to placebo.

In addition, after 30 days, there was enhancement in the enzymes required for nitrogen assimilation and excretion via the urea cycle, with greater secretion of urinary hippurate (p = 0.0299) in the FMT group.

It was also clear that the use of FMT reduced biomarkers of inflammation but increased biomarkers for gut barrier repair.

The researchers concluded that their data supported a role for FMT in patients with cirrhosis.

Following the PROFIT trial, the same group are about to embark on the PROMISE trial, in which patients with cirrhosis take capsules containing dried stool from a healthy donor, rather than via endoscopy as in the PROFIT trial.

A recent Cochrane review found that faecal transplantation improves clinical and possibly endoscopic remission in ulcerative colitis.

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