Hepatitis: India

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Alcoholic hepatitis

ILBS uses stool transplant in treatment

DurgeshNandan Jha, Stool transplant may help tackle hepatitis, March 28, 2017: The Times of India

Researchers at Institute of Liver and Biliary Sciences (ILBS) have successfully completed a pilot study on using stool transplant to treat severe alcoholic hepatitis. The process involved delivery of pre-screened, healthy stool to a patient from a relative.

The result of the research, which has been peer-reviewed and published in the latest issue of Clinical Gastroenterology and Hepatology -a reputed medical journal, shows 87.5% of such patients survived for over a year compared to 33.3% of those receiving standard treatment.

The hospital got 195 patients with alcoholic liver disease from December 2014 to February 2015 when the study was conducted, said Dr Cyriac Abby Philips, the lead researcher. Of this, 51had severe alcoholic hepatitis in which one-month survival chance is less than 50% and 38 were steroid ineligible, which reduces survival chance even further.They were offered stool transplant as a rescue therapy in the absence of any other option and eight patients gave consent, Dr Philips said.

Dr S K Sarin, director of ILBS, said each patient was given pre-screened and sterilised stool taken from a relative and the same was put into his small and large intestine via a nasal tube for seven days. “Indices of liver disease severity improved significantly within the first week compared to those who received standard therapy ,“ he said.

The positive effect continued and during a median follow-up of 355 days, ascites (abnormal accumulation of fluid in abdominal cavity) was seen to resolve in five (57.1%) and hepatic encephalopathy (decline in brain function as a result of severe liver disease) in six (71.4%) patients. “Oneyear survival in patients who underwent transplant was 87.5% compared to 33.3% in those who received standard therapy for improvement in sepsis, nutritional rehabilitation and abstinence from alcohol. Also, many patients who received stool transplant may not require transplant, which is a major success,“ he added.

Stool has a massive reserve of bacteria and it helps modulate gut microbiota in patients suffering from severe alcoholic hepatitis, said Dr Sarin, explaining the science behind this success. “Our research also indicates that new species from the donor, which are less pathogenic and beneficial, coexist with pre-existing bacterial communities of the recipient and the latter gets substantially modified by the donor species.“

Every year, one lakh people die in India due to liver failure. Of this, many patients suffer from alcoholic liver diseases where steroid administration or organ transplants are only treatment options.Both are costly and come with the risk of complications.Stool transplant, on the other hand, is a cheap procedure, costing a few thousands only .

Experts said the research gave many patients hope. “We have used stool transplant only for patients who were ineligible for steroid treatment. But now we plan to try it on those eligible for steroid treatment as steroids have known complications. Also, it can be used to overcome antibiotic failure in future,“ said Dr Sarin.

Dr Anupam Sibal, senior paediatric gastroenterologist at Apollo Hospital, said stool transplant had already been used for treating antibiotic-induced diarrhoea and Crohn's disease.

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