A Systematic Review of the Efficacy and Safety of Fecal Microbiota Transplantation in the Treatment of Hepatic Encephalopathy and Clostridioides difficile Infection in Patients With Cirrhosis

Tun, Kyaw Min; Hong, Annie; Batra, Kavita; Naga, Yassin; Ohning, Gordon V.

doi:10.7759/cureus.25537

Cited by 9 publications

(4 citation statements)

References 34 publications

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“…Several complications of LC are associated with the intestinal microbiome but are represented also by jaundice, HE, ascites, variceal bleeding, spontaneous bacterial peritonitis and infections [26,73]. Out of these, HE is the one that causes the most frequent hospital admissions, placing a heavy burden not only on the patient, but also on the caregivers and healthcare systems [74]. In patients with cirrhosis, hospitalizations are more common and antibiotic use is more prevalent, increasing their likelihood of contracting CDI [74].…”

Section: Liver Cirrhosis (Lc)mentioning

confidence: 99%

“…Out of these, HE is the one that causes the most frequent hospital admissions, placing a heavy burden not only on the patient, but also on the caregivers and healthcare systems [74]. In patients with cirrhosis, hospitalizations are more common and antibiotic use is more prevalent, increasing their likelihood of contracting CDI [74].…”

Section: Liver Cirrhosis (Lc)mentioning

confidence: 99%

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Fecal Microbiota Transplantation in Liver Cirrhosis

Boicean,

Birlutiu,

Ichim

et al. 2023

Biomedicines

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The human gastrointestinal tract houses a diverse array of probiotic and pathogenic bacteria and any alterations in this microbial composition can exert a significant influence on an individual’s well-being. It is well-established that imbalances in the gut microbiota play a pivotal role in the development of liver diseases. In light of this, a new adjuvant therapy for liver diseases could be regulating the intestinal microbiota. Through fecal microbiota transplantation, patients whose microbiomes are compromised are treated with stool from healthy donors in an attempt to restore a normal microbiome and alleviate their symptoms. A review of cross-sectional studies and case reports suggests that fecal microbiota transplants may offer effective treatment for chronic liver diseases. Adding to the potential of this emerging therapy, recent research has indicated that fecal microbiota transplantation holds promise as a therapeutic approach specifically for liver cirrhosis. By introducing a diverse range of beneficial microorganisms into the gut, this innovative treatment aims to address the microbial imbalances often observed in cirrhotic patients. While further validation is still required, these preliminary findings highlight the potential impact of fecal microbiota transplantation as a novel and targeted method for managing liver cirrhosis. We aimed to summarize the current state of understanding regarding this procedure, as a new therapeutic method for liver cirrhosis, as well as to explain its clinical application and future potential.

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Section: Liver Cirrhosis (Lc)mentioning

confidence: 99%

Section: Liver Cirrhosis (Lc)mentioning

confidence: 99%

Fecal Microbiota Transplantation in Liver Cirrhosis

Boicean,

Birlutiu,

Ichim

et al. 2023

Biomedicines

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“…Another treatment for SIBO is fecal transplantation, which was shown to be effective in one randomized controlled trial in patients without cirrhosis [48]. Although several studies on the effectiveness of fecal transplantation for cirrhosis have been published [49][50][51], none examined how this procedure affects SIBO, which represents a challenge for future research.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of a Probiotic Containing Saccharomyces boulardii CNCM I-745 in the Treatment of Small Intestinal Bacterial Overgrowth in Decompensated Cirrhosis: Randomized, Placebo-Controlled Study

Efremova,

Maslennikov,

Zharkova

et al. 2024

JCM

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(1) Background: The aim was to evaluate the effectiveness of the probiotic containing Saccharomyces boulardii in the treatment of small intestinal bacterial overgrowth (SIBO) in patients with decompensated cirrhosis. (2) Methods: This was a blinded, randomized, placebo-controlled study. (3) Results: After 3 months of treatment, SIBO was absent in 80.0% of patients in the probiotic group and in 23.1% of patients in the placebo group (p = 0.002). The patients with eliminated SIBO had decreased frequency of ascites and hepatic encephalopathy, the increased platelets and albumin levels, the decreased blood levels of total bilirubin, biomarkers of bacterial translocation (lipopolysaccharide [LPS]) and systemic inflammation (C-reactive protein), and positive changes in markers of hyperdynamic circulation compared with the state at inclusion. There were no significant changes in the claudin 3 level (the intestinal barrier biomarker) in these patients. No significant changes were observed in the group of patients with persistent SIBO. The serum level of nitrate (endothelial dysfunction biomarker) was lower in patients with eradicated SIBO than in patients with persistent SIBO. One (5.3%) patient with eradicated SIBO and six (42.9%) patients with persistent SIBO died within the first year of follow-up (p = 0.007). (4) Conclusions: SIBO eradication was an independent predictor of a favorable prognosis during the first year of follow-up.

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“…The rationale behind the use of FMT in cirrhotic patients with HE is to modulate gut microbiota composition, thereby reducing the gut dysbiosis which is typical of cirrhotic patients [17,103]. A recent review of eight studies showed long-term improvement in cognitive performance in cirrhotic patients who underwent FMT [104]. However, the clinical applicability of FMT for treating HE remains under investigation.…”

Section: Overview Of Available Pharmacological Treatments For Hementioning

confidence: 99%

Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution

Bellafante

Gioia

Faccioli

et al. 2023

JCM

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Hepatic encephalopathy (HE) is a common complication in patients with advanced liver disease. It is a brain dysfunction characterized by neurological and psychiatric symptoms that significantly affects quality of life, morbidity and mortality of patients. HE has various precipitants that can potentially promote its onset, alone or in combination. Among the historically well-known precipitants, such as infections, gastrointestinal bleeding, dehydration, electrolyte disorders and constipation, recent studies have highlighted the role of malnutrition and portosystemic shunts as new precipitating factors of HE. The identification, management and correction of these factors are fundamental for effective HE treatment, in addition to pharmacological therapy with non-absorbable disaccharides and/or antibiotics.

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A Systematic Review of the Efficacy and Safety of Fecal Microbiota Transplantation in the Treatment of Hepatic Encephalopathy and Clostridioides difficile Infection in Patients With Cirrhosis

Cited by 9 publications

References 34 publications

Fecal Microbiota Transplantation in Liver Cirrhosis

Fecal Microbiota Transplantation in Liver Cirrhosis

Efficacy and Safety of a Probiotic Containing Saccharomyces boulardii CNCM I-745 in the Treatment of Small Intestinal Bacterial Overgrowth in Decompensated Cirrhosis: Randomized, Placebo-Controlled Study

Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution

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