Pentoxyphilline Versus Fecal Microbiota Therapy in Severe Alcoholic Hepatitis

Inclusion criteria

• All patients with a diagnosis of severe alcoholic hepatitis who are steroid ineligible, are non responders or are intolerant
• Severe alcoholic hepatitis defined as Maddrey's Discriminant Function Score (4.6 x (PT test - control))+ S.Bilirubin in mg/dl of more than 32 OR a patient of alcoholic hepatitis (defined as AST:ALT ratio > 2:1) who presents with any grade of hepatic encephalopathy
• Conventional therapy defined as oral steroid therapy (Wysolone ® 40mg once a day for 7 days)
• Failure of therapy defined as a Lille Model Score (http://www.lillemodel.com) of >0.45 at day 8 of steroid therapy OR emergence of complications of steroid therapy or intolerance to steroid protocol or ineligible for steroid therapy.
• Ineligibility for steroid therapy includes - Renal dysfunction, evidence of active sepsis or foci of sepsis, gastro intestinal bleeding and disseminated intravascular coagulation, steroid intolerance, steroid related uncontrolled hyperglycemia which precludes therapy, uncontrolled diabetes mellitus
• A Psychologist will be arranged for recipients who are on Fecal Transplant protocol for psychological support throughout the period of one week, during which the transplant procedure will be performed

• Healthy persons who are willing for faeces donation have to be a close family member
• The donor will be required to give a written consent for faeces donation
• Once consent is taken, the donor will have to undergo the following screening measures:

• Clostridium difficile toxins A and B by EIA
• Routine bacterial culture for enteric pathogens in stool
• Ova and parasites
• Blood serology for viruses - human immunodeficiency virus [HIV, type 1 and 2] HAV IgM, HBsAg, anti HCV Ab

Exclusion criteria

• Active gastrointestinal bleeding
• Intracranial bleeding
• Multi-organ failure on mechanical ventilation
• On high inotropic support
• Paralytic ileus
• Pregnancy
• Sepsis
• Failure to provide consent
• Have abnormal bowel motions
• Have abdominal complaints
• Have symptoms indicative of irritable bowel syndrome
• Have extensive travel history or predisposing factors for potentially transmittable diseases
• Have chronic alcohol intake
• Have history of substance abuse
• Are less than 18 years or more than 60 years of age
• Have HIV and Hepatitis Risk factors
• Have enteric infections
• Have inflammatory bowel disease history
• Have chronic constipation or diarrhea
• Have prior abdominal surgery or GI neoplasms
• Have Metabolic Syndrome
• Have Systemic Autoimmunity
• Have atopic diseases
• Have food and respiratory allergies
• Have any chronic pain syndromes
• Have chronic Neurologic disorders
• Have Neurodevelopmental disorders
• Have had antibiotics for any indication taken within the last 2 months