Novel Treatment for Severe Alcoholic Hepatitis at a Nominal Cost

KOCHI:
The newly introduced treatment method of “Faecal Microbiota Transplant” (FMT) also known as “Stool Transplant” was successfully carried out in Kerala for the first time for the management of severe alcoholic hepatitis, a condition with almost 80% mortality without liver transplant. This landmark treatment was introduced by “Philip Augustine Associates” the healthcare group headed by eminent Gastroenterologist Dr. Philip Augustine at the Liver Unit of PVS Memorials Hospital, Kochi in a 46 years old man from Mavelikkara.
The standard treatment for severe alcoholic hepatitis is corticosteroid therapy, but this treatment only improves one month survival to make a patient eligible for an urgent but controversial liver transplant. There are many patients who are ineligible even for such therapy due to life threatening infections.
Dr. Abby Philips, Managing Director of Philip Augustine Associates and Hepatologist and Chief of Liver Transplant Medicine at PVS Memorial Hospital was the pioneer in inventing this treatment method at the prestigious Institute of Liver and Biliary Sciences (ILBS), New Delhi.
His landmark pilot study was published by the American Gastroenterology Association in their official journal in November 2016. This was later endorsed by the American Association for the Study of Liver (AASLD). Only 23 participants have undergone this treatment in the world, all at ILBS, New Delhi and with an overall survival rate of 87.5% at one year follow up. With the conventional treatment the control group had only 30% survival at one year.
Dr. Abby Philips joined PVS Memorial Hospital recently and introduced this novel treatment method for the first time in the private sector in India. Three more patients are currently undergoing FMT in his liver unit.
FMT was introduced for the treatment of these patients because of the awareness that they die of life threatening infections caused by disease causing bacteria from the gut. This technique involves introducing beneficial bacteria into the small intestine of such patients infected with bad bacteria. This is done by a simple technique of placing a tube through the nose of the patient into the upper part of the small intestine beyond the stomach and giving processed fresh stool samples obtained from a healthy stool donor after ruling out sources of any infection in the stool sample. Such stool transfer is done on seven consecutive days. The transformation in the bacterial flora of the patient is monitored and confirmed by genomic studies in the stool sample obtained from the patient before and after transplant for a period of one year.
FMT as a therapeutic tool is currently approved for treatment of severe Clostridium Difficile Infection (a life
threatening condition called Pseudomembranous Colitis). Trials are underway in other troublesome
gastrointestinal diseases like Ulcerative Colitis and Crohn’s Disease.
Dr. Abby Philips said in a press release that considering the ease of administration and the nominal cost involved, FMT which has by now attracted worldwide attention may well become the standard of care for the management of severe alcoholic hepatitis in the near future.