Auto brewery syndrome from the perspective of the neurologist

Ser, Merve Hazal; Çalıkuşu, Fatma Zehra; Erener, Nursena; Destanoğlu, Orhan; Síva, Aksel

doi:10.1016/j.jflm.2023.102514

Cited by 3 publications

(1 citation statement)

References 11 publications

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“…In contrast, recurrent acute ethanol intoxication without drinking or spontaneous inebriation occurs in untreated GFS patients [ 26 – 28 , 30 , 31 ]. Untreated GFS is also speculated to cause chronic ethanol intoxication in various organs, such as fatty liver disease.…”

Section: Comparison Between Gfs and Bfsmentioning

confidence: 99%

Gut and bladder fermentation syndromes: a narrative review

Tamama,

Kruckenberg,

DiMartini

2024

BMC Med

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We recently reported the first clinical case of bladder fermentation syndrome (BFS) or urinary auto-brewery syndrome, which caused the patient to fail abstinence monitoring. In BFS, ethanol is generated by Crabtree-positive fermenting yeast Candida glabrata in a patient with poorly controlled diabetes. One crucial characteristic of BFS is the absence of alcoholic intoxication, as the bladder lumen contains transitional epithelium with low ethanol permeability. In contrast, patients with gut fermentation syndrome (GFS) or auto-brewery syndrome can spontaneously develop symptoms of ethanol intoxication even without any alcohol ingestion because of alcoholic fermentation in the gut lumen. In abstinence monitoring, a constellation of laboratory findings with positive urinary glucose and ethanol, negative ethanol metabolites, and the presence of yeast in urinalysis should raise suspicion for BFS, whereas endogenous ethanol production needs to be shown by a carbohydrate challenge test for GFS diagnosis. GFS patients will also likely fail abstinence monitoring because of the positive ethanol blood testing. BFS and GFS are treated by yeast eradication of fermenting microorganisms with antifungals (or antibiotics for bacterial GFS cases) and modification of underlying conditions (diabetes for BFS and gut dysbiosis for GFS). The under-recognition of these rare medical conditions has led to not only harm but also adverse legal consequences for patients, such as driving under the influence (DUI). GFS patients may be at risk of various alcohol-related diseases.

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Section: Comparison Between Gfs and Bfsmentioning

confidence: 99%

Gut and bladder fermentation syndromes: a narrative review

Tamama,

Kruckenberg,

DiMartini

2024

BMC Med

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Endogenous ethanol production in health and disease

Meijnikman,

Nieuwdorp,

Schnabl

2024

Nat Rev Gastroenterol Hepatol

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Gut fermentation syndrome as an alibi for a driver tested positive for alcohol: a case-based discussion

Toruńska,

Engelgardt,

Krzyżanowski

2024

Problems of Forensic Sciences

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The intestinal fermentation syndrome (IFS) also known as the auto-brewery syndrome (ABS), is an extremely rare diagnosis. This syndrome involves the endogenous production of alcohol by microorganisms in the digestive system after consuming a high-carbohydrate meal. The article describes the case of a 65-year-old driver who was found to have 0.24 mg/l of alcohol during a sobriety test, which, according to Polish law, is defined as a state after consuming alcohol and is considered a misdemeanour. He explained his condition by the occurrence of the intestinal fermentation syndrome. After a thorough analysis of the documentation submitted, it was concluded that there was no basis for assuming that the ethyl alcohol found in the exhaled air resulted from the accused’s health condition, medications taken by him or meals consumed, and the presence of the discussed disease was excluded. The specificity of the intestinal fermentation syndrome encourages the use of the diagnosis as an alibi for alcohol detected in the body. Hence, in such cases, it is important to carefully conduct diagnostics, including differential diagnosis, microbiological tests and, above all, a provocation test with glucose with simultaneous monitoring of the alcohol level in the body. During diagnostics, the possibility of additional alcohol intake should also be excluded to avoid false results and misdiagnosis.

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Auto brewery syndrome from the perspective of the neurologist

Cited by 3 publications

References 11 publications

Gut and bladder fermentation syndromes: a narrative review

Gut and bladder fermentation syndromes: a narrative review

Endogenous ethanol production in health and disease

Gut fermentation syndrome as an alibi for a driver tested positive for alcohol: a case-based discussion

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