AUTO-BREWERY SYNDROME or gut fermentation syndrome is a condition in which ethanol is produced through endogenous fermentation by fungi or bacteria in the gastrointestinal system, oral cavity, or urinary system. Patients with auto-brewery syndrome present with many of the signs and symptoms of alcohol intoxication while denying an intake of alcohol and often report a high-sugar, high-carbohydrate diet.
The production of endogenous ethanol occurs in minute quantities as part of normal digestion, but when fermenting yeast or bacteria become pathogenic, extreme blood alcohol levels may result. Auto-brewery syndrome is more prevalent in patients with co-morbidities such as diabetes, obesity, and Crohn disease but can occur in otherwise healthy individuals. Several strains of fermenting yeasts and rare bacteria are identified as pathogens. While auto-brewery syndrome is rarely diagnosed, it is probably underdiagnosed. Even rarer are two cases of auto-brewery syndrome identified, one in the oral cavity and one in the urinary bladder.
ETIOLOGY:-
Various yeasts from the Candida and Saccharomyces families are commensals turned pathogenic that cause auto-brewery syndrome. Several strains of bacteria are also known to ferment ethanol.
Fermenting yeasts such as Saccharomyces cerevisiae, S. boulardii, and various strains of Candida, including C. glabrata, C. albicans, C. kefyr, and C. parapsilosis are identified as causes of this condition.
The bacteria Klebsiella pneumonia, Enterococcus faecium, E. faecalis, and Citrobacter freundii are implicated in at least one case each.
Existing conditions, such as diabetes or liver problems, can impact the diagnosis of ABS. Patients with type 2 diabetes mellitus (DM) or liver cirrhosis (LC) tested higher for endogenous ethanol (EnEth) levels than a control group without the disease. But the EnEth levels peaked highest in a group of patients with both type 2 DM and LC, where the blood alcohol concentration reached 22.3 mg/dL.
Four common yeasts (Candida albicans, Candida tropicalis, Saccharomyces cerevisiae, and Torulopsis glabrata) were combined with infant formulas. Ethanol production was measured after 24 and 48 hours. The quantities of ethanol produced suggest an explanation for patients exhibiting auto-brewery syndrome.
Bacterial production of EnEth is involved in the development of non-alcoholic fatty liver disease (NAFLD). Higher levels of EnEth are also detected in obese patients and those with non-alcoholic steatohepatitis.
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