Auto-Brewery Syndrome: Pathophysiology, Clinical Presentation, Diagnosis, Treatment and Social Implications

Abstract

Auto-brewery syndrome (ABS), also known as gut fermentation syndrome or endogenous ethanol fermentation, is a rare and underreported phenomenon in modern medicine. Individuals with this syndrome may experience intoxication, mimicking alcoholism, and face medical and social implications, including potential arrest for impaired driving. The pathophysiology of ABS is attributed to a fungal-type dysbiosis of the gut, where certain carbohydrates are fermented into ethanol, potentially mimicking food allergies or intolerances. This syndrome typically occurs in individuals with chronic gastrointestinal issues, such as obstruction or hypomotility, presenting with elevated breath and blood alcohol concentrations, particularly after high carbohydrate intake. A glucose challenge test and other alcohol biomarkers can serve as confirmatory tests. The syndrome mechanism involves factors like imbalance gut flora and an overgrowth of yeast or bacteria in the gut, which ferments carbohydrates and produces high levels ethanol. Clinical presentation includes symptoms of intoxication, gastrointestinal symptoms, and elevated blood alcohol levels. Diagnosis is challenging and requires a comprehensive approach, including clinical history, laboratory tests, and imaging studies. Treatment involves dietary modifications, antifungal or antibacterial therapy, and probiotics. Social implications are significant, with potential consequences for personal and professional relationships, work, and daily life. Awareness and understanding among healthcare professionals and the public are essential for proper diagnosis and management of this condition. Further research on the human microbiome is needed to understand how imbalances in commensal bacteria allow yeast to colonize at pathological levels.