Identifying rare pathologies often requires complex clinical research and a detailed analysis of the patient’s condition. In the case of Auto-Brewery Syndrome (ABS), the diagnostic process is often hindered by existing protocols and inaccurate medical assumptions. A new study addresses the challenges in the field and offers simplified, evidence-based methods for determining the disease.
What is Auto-Brewery Syndrome?
Auto-Brewery Syndrome (ABS), also known in medical literature as gut endogenous fermentation syndrome, causes intoxication of the organism without the consumption of alcohol. During the pathological process, the intestinal microflora synthesizes excessive amounts of ethanol from carbohydrates, which subsequently enters the systemic circulation. Clinically, this condition is characterized by speech dysfunction, impaired coordination, and behavioral changes.
Diagnosing the pathology represents a complex clinical challenge. Inpatient observation and the determination of peak ethanol concentration in blood plasma against a background of a glucose challenge test is considered the “gold standard” for diagnosis verification.
Patients often become victims of inadequate medical evaluations and social stigmatization. The exact etiology of the disease is still a subject of research, though it is frequently linked to Crohn’s disease and functional liver disorders. According to the latest scientific data, the proliferation of bacteria of the genus Klebsiella plays a leading role in the development of the pathology.
Study Design
In the initial stage, researchers evaluated 91 candidates, ultimately including 22 patients with confirmed ABS and 21 healthy individuals in the final analysis. In the clinical group, the majority of patients were men. Their medical histories recorded elevated levels of liver enzymes (ALT, AST), alkaline phosphatase, and bilirubin.
During the phase of symptom exacerbation, the concentration of alcohol in exhaled air averaged 136 mg/dL. Notably, a portion of the patients frequently used antifungal medications before being diagnosed. After identifying the condition, patients also removed starch-containing products from their diet.
Microbiome Dysbiosis
Genetic sequencing confirmed a sharp dysbiosis of the intestinal microflora. During the period of symptom exacerbation, against a background of reduced microbial diversity, the population of bacteria from the Enterobacteriaceae family increased significantly. Escherichia coli and Klebsiella pneumoniae were named as the main driving forces of this pathological process. Simultaneously, the levels of beneficial anaerobic bacteria dropped to a minimum due to species deficiency.
It is also noteworthy that the antibiotic chloramphenicol sharply inhibited this process, whereas antifungal preparations did not have a significant impact on the result. The obtained data testify that the primary cause of ABS is bacterial proliferation rather than fungal cultures (yeast).
Fecal Microbiota Transplantation (FMT)
In one patient, clinical signs of Auto-Brewery Syndrome (ABS) emerged after completing antibiotic therapy for the prostate. As a result of initial Fecal Microbiota Transplantation (FMT), a three-month remission was recorded. After a relapse of the disease, specialists utilized combined therapy: potent antibiotics and capsules containing donor microflora. Thanks to this intervention, the patient has been symptom-free for more than 16 months and is returning to a carbohydrate-rich diet without restrictions.
Thus, research into ABS once again confirms the fundamental role of the intestinal microbiome in metabolic processes. Replacing traditional approaches with molecular analysis and targeted reconstruction of the microflora provides a real possibility for curing patients.
Source: nature
