Rare condition auto-brewery syndrome linked to specific gut bacteria

A new study found gut bacteria, including Escherichia coli and Klebsiella pneumoniae, can ferment sugars into ethanol in people with auto-brewery syndrome, and stool samples from 22 patients produced significantly more ethanol than samples from 21 household controls.

Researchers studied a rare condition called auto-brewery syndrome (ABS), in which some people's intestines produce alcohol and can cause intoxication without drinking. The condition is often missed because it is uncommon and not widely recognised. In the largest study to date, scientists compared 22 patients with 21 unaffected household partners to look for microbes linked to ABS. The work aimed to identify specific bacteria and pathways that generate ethanol and to inform future diagnostic or treatment approaches. Key findings: - Stool samples from 22 patients during ABS flares produced significantly more ethanol in laboratory tests than samples from 21 unaffected household partners. - Researchers identified gut bacteria, including Escherichia coli and Klebsiella pneumoniae, that can ferment sugars into ethanol in patients with ABS. - Ethanol production from patient stool samples could be reduced in vitro after antibiotic treatment, according to the study. - One patient appeared to experience symptom relief after fecal microbiota transplantation and was reported symptom-free for more than 16 months after a second transplant. Summary: The study identifies specific microbes and microbial pathways that can produce clinically meaningful alcohol in some people, offering a clearer biological explanation for symptoms that have previously led to long delays in diagnosis. Researchers described the findings as a basis for developing better tests and treatments, but how this will change clinical practice is undetermined at this time.