Fecal Transplant for Hepatic Encephalopathy
Fecal Transplant for Hepatic Encephalopathy
The purpose of the study is to determine if fecal microbiota transplant (FMT) can reverse
 hepatic encephalopathy (HE) in cirrhotic patients who continue to have breakthrough episodes
 of HE despite maintenance therapy with lactulose and/or rifaximin or metronidazole.
Subjects receive FMT from a single donor by colonoscopy at week 0 and by enema at weeks 1-4.
 HE is measured by Inhibitory Control Test (ICT) and Stroop test as well as fasting serum
 ammonia levels.
Inclusion Criteria:

 -  Adult cirrhotic patients of various etiology on lactulose and/pr rifaximin or
 metronidazole for minimum 4 weeks as secondary prophylaxis

 -  Abnormal ICT (>5 lures) or abnormal Stroop test (>200 seconds)

 -  Baseline Conn score 0 or 1

 -  Infectious etiology of HE has been ruled out

 Exclusion Criteria:

 -  those with tense ascites

 -  those who do not provide assent

 -  life expectancy <3 months

 -  TIPS within the past 3 months

 -  neurologic disease such as dementia, Parkinson's, structural brain lesions

 -  pregnancy

 -  intestinal obstruction

 -  alcoholic hepatitis

 -  active alcohol or substance abuse

 -  those without stable social support

 -  concurrent infection such as spontaneous bacterial peritonitis, pneumonia or urinary
 tract infection

 -  creatinine clearance less that 50% compared to baseline

 -  hospital admission for HE within one month of enrollment

 -  active hepatocellular carcinoma

 -  active GI bleed