Auto-brewery syndrome

Auto-brewery syndrome (ABS), also referred to as gut fermentation syndrome, endogenous ethanol fermentation, or drunkenness disease, is a rare medical condition characterized by the production of ethanol, an intoxicating substance, within the human body. This is caused by an overgrowth of specific types of yeast and bacteria in the gastrointestinal tract that ferment ingested carbohydrates.

Pathophysiology

The pathogenesis of ABS involves the conversion of dietary carbohydrates into alcohol (ethanol) by microbes residing in the digestive tract. These microbes, predominantly yeasts and bacteria such as Saccharomyces cerevisiae, S. boulardii, Candida species (including C. albicans, C. tropicalis, C. krusei, C. glabrata, and C. kefyr), C. parapsilosis, Klebsiella pneumoniae, and Enterococcus faecium, use lactic acid fermentation or mixed acid fermentation pathways to produce ethanol as an end product.

Clinical Features

Individuals with ABS may experience symptoms of inebriation, including dizziness, disorientation, and slurred speech, despite not consuming alcohol. The onset of these symptoms can occur after meals rich in carbohydrates.

Diagnosis and Treatment

The diagnosis of ABS is challenging due to its rarity and overlapping symptoms with other conditions. It usually involves tests to measure blood alcohol concentration over time following a carbohydrate-rich meal. Treatment typically includes dietary modifications to limit carbohydrate intake and antibiotics or antifungal medications to reduce the population of fermenting microbes.

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References

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1. Cordell B, Kanodia A, Miller GK. "Case-control research study of Auto-Brewery Syndrome." Global Advances in Health and Medicine. Case-control research study of Auto-Brewery Syndrome
2. Spinucci G, Guidetti M, Lanzoni E, Pironi L. "Endogenous ethanol production in a patient with chronic intestinal pseudo-obstruction and small intestinal bacterial overgrowth." European Journal of Gastroenterology & Hepatology. Endogenous ethanol production
3. Yokoyama A, Omori T. "Auto-Brewery Syndrome (Gut Fermentation)." BioPsychoSocial Medicine. Journal article