Faecal microbiota transplantation (FMT) significantly improves alcohol abstinence and reduces relapse episodes for up to 6 months in patients with alcohol-related liver disease (ALD) and alcohol use disorder (AUD), as shown in a recent study presented at EASL 2026.
At 3 months, over 20 percent of participants receiving FMT remained abstinent, suggesting that modifying the gut microbiome could provide a new approach to targeting the gut-brain axis and reducing alcohol craving in this population.
“Faecal microbiota transplantation works,” said study author Dr Srajit Singh, a hepatologist at the Institute of Liver and Biliary Sciences in New Delhi, India. “For ALD, we have to treat the cause, which is alcohol. However, addiction is a major problem, and treatment options are limited.”
AUD worsens outcomes in ALD, which has limited approved pharmacological therapies and a high relapse rate. Gut dysbiosis is increasingly linked to alcohol craving, relapse, and disease progression. Preliminary studies have shown that FMT may reduce alcohol craving. However, data on patients with ALD, particularly from Asia, remain scarce.
Singh and colleagues sought to evaluate the safety and efficacy of FMT as an adjunctive therapy for AUD in 54 men with ALD. [EASL 2026, abstract TOP-208-YI]
The primary endpoint was alcohol abstinence at 1 month. Secondary endpoints included abstinence at 3 and 6 months, lapse and relapse severity, and craving scores. Changes in the gut microbiota were also assessed using 16S metagenomic analysis.
Adjunct FMT gets the job done
Participants were randomly assigned to receive standard medical treatment alone (baclofen, AUD counselling, and psychiatric support) or standard medical treatment plus a single FMT session. Faecal microbiota was obtained from healthy blood relatives (aged 35 years, non-smokers, and non-drinkers) and delivered via upper gastrointestinal endoscopy.
The investigators performed 16S ribosomal RNA sequencing of stool samples collected before and after FMT. Patients who remained abstinent showed enrichment of several potentially beneficial bacterial taxa, including members of the Ruminococcaceae and Bifidobacteriaceae families. All patients were followed for 6 months.
At 3 months, complete alcohol abstinence was achieved in 22 percent of patients receiving FMT vs none in those receiving standard treatment alone (p=0.023).
The benefit was greatest early in treatment. At 1 month, abstinence rates were 52 percent in the FMT group and 33 percent in the control group. The difference was not statistically significant.
Relapse rates were lower with FMT. At 3 months, moderate relapse occurred in 41 percent of FMT-treated patients vs 74 percent of controls (p=0.027). By 6 months, moderate relapse rates were 48 percent and 100 percent, respectively (p<0.001).
Additionally, patients receiving FMT experienced significant reductions in alcohol-craving scores (p<0.05 for FMT vs standard care). Model for End-Stage Liver Disease scores, a marker of liver disease severity, improved more rapidly and to a greater extent in the FMT group than in the control group.
Sequential therapy warranted
Although the benefit was most evident at 3 months, it seemed to decrease over time. Therefore, future studies might consider assessing sequential treatment to monitor long-term effects.
“After that [3 months], there was a trend suggesting the effect may be starting to wear off. A second dose around 3 months may be beneficial,” said Singh. He added that more randomized controlled trials with longer follow-up periods are needed.