Auto-Brewery Syndrome: Pathophysiology, Clinical Presentation, Diagnosis, Treatment and Social Implications
Jacques Forwah Ndeh *
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Edeani Bobby David
Department of Radiation Oncology, University of Nigeria Teaching Hospital, Ituku- Ozalla, Enugu State, Nigeria.
Arinze Joseph Edochie
Queen Elizabeth Hospital Birmingham -UHB NHS Trust, United Kingdom.
Emekwue Chukwudi Alex
Department of Internal Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria.
Edung Emem Samuel
Emergency Department, Basildon and Thurock University Hospital London NHS Trust, United Kingdom.
Awu Hogan Eyo
Department of Family Medicine, Cedarcrest Hospital, Abuja, Nigeria.
Abayomi Oluwatobi Opadijo
Department of Internal medicine, University of Worthing, United Kingdom.
Olukotun Stephen Tobi Abraham
Belmedicare Hospital Lagos, Lagos State, Nigeria.
Orajekwe Sharon Makuochukwu
Department of Internal Medicine, Zenith Medical and Kidney Center, Abuja, Nigeria.
Ebenyi Benjamin Ede
General Practices (Primary Health Care), Jobi Clinic and Maternity, Ikorodu, Lagos State, Nigeria.
Okoye Chukwuebuka Daniel
Department of Pediatrics, Asaba Specialist Hospital, Asaba, Delta State, Nigeria.
Khadija Garba Nabayi
Department of Pediatrics, Cedar Pediatrics Clinic, Kaduna, Kaduna State, Nigeria.
Worship Tega Ewhrudjakpor
Department General Medicine, York and Scarborough Hospital, NHS Foundation Trust, United Kingdom.
Adaugo Olga Maduabuchukwu
Monash Specialist Hospital, 3A Monash Close, Off Ada-Gorge Road Mgbuoha, Port Harcourt, Rivers State, Nigeria.
Patience Gaji Udi
Department of Radiology, Barau Dikko Teaching Hospital Kaduna State, Nigeria.
Falade Feyisayo Bolu
Department of Accident and Emergency, Nigeria Air Force Hospital, Abuja, Nigeria.
Azeez Sulaimon Ademola
Department of General Surgery, University of Ilorin, Kwara State, Nigeria.
Chinedum Michael Onah
Department of Mental, South Eastern Health and Social Care, Belfast, NHS Trust, United Kingdom.
John Monijesu Ajide
Blue Cross Hospital Ogba, Lagos State, Nigeria.
Immaculate Ihuoma Ekeagba
WORCACCCE UNION GROUP Integrated Healthcare Sciences, Technological development and Training and Innovative Research Foundation (WUGIHSTTAIRF), P.O Box 45 Bamenda, North West Region, Cameroon.
Akaba Kingsley Onoride
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Abeshi Sylvester Etenikang
Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
*Author to whom correspondence should be addressed.
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.
Keywords: Auto-brewery syndrome, pathophysiology, clinical presentation, diagnosis, treatment complications and social implications