The Auto-Brewery Syndrome: A Perfect Metabolic "Storm" with Clinical and Forensic Implications.

Ricardo Jorge Dinis-Oliveira

doi:10.3390/jcm10204637

Abstract

Auto-brewery syndrome (ABS) is a rare, unstudied, unknown, and underreported phenomenon in modern medicine. Patients with this syndrome become inebriated and may suffer the medical and social implications of alcoholism, including arrest for inebriated driving. The pathophysiology of ABS is reportedly due to a fungal type dysbiosis of the gut that ferments some carbohydrates into ethanol and may mimic a food allergy or intolerance. This syndrome should be considered in patients with chronic obstruction or hypomotility presenting with elevated breath and blood alcohol concentrations, especially after a high carbohydrate intake. A glucose challenge test should be performed as the confirmatory test. Treatment typically includes antifungal drugs combined with changes in lifestyle and nutrition. Additional studies are particularly needed on the human microbiome to shed light on how imbalances of commensal bacteria in the gut allow yeast to colonize on a pathological level.

Highlights

Auto-brewery syndrome (ABS; known as gut fermentation syndrome, endogenous ethanol fermentation or drunkenness disease) is a rare medical condition in which intoxicating quantities of ethanol are produced through the endogenous fermentation of carbohydrates within the digestive system, which has already been described in children and adults of both sexes [1]
Some individuals might suffer from these consequences, being misdiagnosed as ethanol abusers, without consuming any ethanol due to ABS
This rare syndrome affects people worldwide, and very little is known about the lifestyle, health, diet, and medical history of these patients [6]

Summary

Introduction

Auto-brewery syndrome (ABS; known as gut fermentation syndrome, endogenous ethanol fermentation or drunkenness disease) is a rare medical condition in which intoxicating quantities of ethanol are produced through the endogenous fermentation of carbohydrates within the digestive system, which has already been described in children and adults of both sexes [1]. The yeast Saccharomyces cerevisiae (i.e., brewer’s yeast), well known for its use in producing bread and alcoholic beverages, and taken by some people as a probiotic supplement, has been identified as the main causative agent for this condition, but several other microorganisms have been identified, including bacteria [2]. ABS has been mainly described to occur in patients with short bowel syndrome after surgical resection, required in the context of Crohn’s disease in adults and necrotizing enterocolitis in young children [4]. A very interesting review was provided by [2]

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