A Review of Recent Advances in Fecal Microbiota Transplantation for the Treatment of Hepatic Encephalopathy.

Nov 9, 2025Medical science monitor : international medical journal of experimental and clinical research

New Insights into Fecal Transplants for Treating Liver-Related Brain Issues

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Abstract

Hepatic encephalopathy (HE) is a serious brain condition that can happen in people with liver problems, leading to various mental issues. Recent research shows that the gut and its bacteria play a big role in this condition. Fecal microbiota transplantation (FMT) is a procedure where healthy gut bacteria from a donor are given to a patient with HE. This treatment helps restore healthy gut bacteria, reduces harmful substances, and can improve brain function. FMT is generally safe and has shown positive results in helping HE patients feel better and stay out of the hospital. This review explains how gut bacteria affect HE, how FMT works, the benefits seen in patients, and discusses future possibilities for this treatment.

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Hepatic encephalopathy (HE) results from a debilitating complication of liver cirrhosis and acute liver failure, characterized by neuropsychiatric abnormalities ranging broadly from mild cognitive impairment to respiratory failure to coma. The pathogenesis of HE is multifactorial, with gut-derived toxins, particularly ammonia, playing a central role. Recent advances in understanding the gut-liver-brain axis have revealed the importance of gut microbiota and dysbiosis in the development and progression of HE. Fecal microbiota transplantation (FMT), a clinical procedure that is performed to transfer fecal microbiota from a healthy donor to a patient with HE (recipient), has emerged as a promising therapeutic strategy for modulating gut microbiota and ameliorating HE. FMT facilitates the restoration of gut microbiota composition with increased microbial alpha diversity, reestablishment of the balance between beneficial and pathogenic bacteria, reduction in the production of gut-derived toxins, and improvement of intestinal barrier function. It also modulates immune and inflammatory responses, alleviating hepatocyte and biliary injury. FMT has also demonstrated efficacy in improving cognitive function and reducing hospitalizations in HE patients and can maintain a stable donor-like microbiota profile for up to 12 months post-transplantation. FMT is generally well-tolerated, with most adverse events reported to be mild and transient, providing a desirable option for HE treatment. This review provides a comprehensive overview of the current understanding of the role of gut microbiota in the pathogenesis of HE, the mechanisms underlying the therapeutic effects of FMT, and the clinical evidence supporting its use in HE. We will also discuss the limitations, challenges, and future prospects for FMT in the treatment of HE.

Abstract

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