Digital International Liver Congress: Alcohol cravings could be reduced by changing gut microbiota, new study reveals

The importance of gut microbiota in reducing the burden of alcohol-related liver disease and liver cancer has been demonstrated in a novel pilot study presented at The Digital International Liver Congress(TM) 2020.

The study examined whether the transfer of fecal bacteria from a healthy individual to a patient (FMT) could reduce cravings for alcohol as the first step for use in subsequent larger trials.

In a pilot, double-blind, placebo-controlled, randomized clinical trial, 20 patients with alcohol use disorder, who had tried several options to quit alcohol unsuccessfully, were given FMT or placebo. FMT was shown to reduce alcohol cravings as well as the total and psychosocial sickness impact profile at Day 15 post-treatment. A corresponding significant increase in microbiota diversity was also seen in FMT patients compared with baseline patients.

Imbalances in gut microbiota have been implicated as contributing to alcoholic liver disease and this study raises the possibility of exploiting gut microbiota management to improve patient outcomes.

In cases of chronic alcohol use, reactive oxygen species produced by alcohol metabolism can lead to chronic intestinal inflammation, which can increase gut permeability and alter microbiota composition. Increased gut permeability is believed to lead to the relocation of gut bacterial DNA and endotoxins to the liver. The latter are thought to induce inflammatory pathways associated with the development of liver diseases, including cancer.

"FMT was safe and showed an impact on reducing short-term alcohol cravings and improving psychosocial quality of life in patients with cirrhosis and alcohol use disorder," commented ILC study presenter Dr Jasmohan Bajaj of McGuire VA Medical Center, USA. "The relative abundance of short-chain fatty acid-producing bacteria identified in patients with higher diversity after FMT demonstrates that altering the gut–brain axis is a potential avenue to alleviating alcohol use disorder in those with cirrhosis."

"The understanding of interactions between the human and microbiome genome in health and disease has represented one of the major areas of progress in the last few years," said Professor Luca Valenti, an EASL Scientific Committee member from the University of Milan, Italy. "This study lays the groundwork for exploiting this new knowledge in the treatment of liver disease."