Auto-brewery syndrome eased after fecal transplant in a reported case

A Nature Microbiology study linked excess alcohol-producing gut bacteria — including Escherichia coli and Klebsiella pneumoniae — to auto-brewery syndrome, and reports one patient whose symptoms waned after repeated oral fecal-transplant capsules over 16 months.

Researchers report new findings about auto-brewery syndrome (ABS), a rare condition in which gut microbes produce intoxicating levels of alcohol. The study, published in Nature Microbiology and led by teams at UC San Diego and Mass General Brigham, analyzed stool samples and clinical data from people with ABS and their partners to identify microbes and metabolic pathways linked to the condition. ABS is uncommon, with fewer than a hundred cases reported worldwide, but it can cause liver and cognitive problems as well as digestive symptoms. The study also describes treatment experiences, including a patient who received multiple doses of oral fecal-transplant capsules and showed reduced symptoms after 16 months. Key findings: - The study observed 22 patients with ABS and 21 unaffected partners as comparison subjects. - Stool samples from ABS patients commonly had excess concentrations of bacteria such as Escherichia coli and Klebsiella pneumoniae. - Researchers identified ethanol-producing metabolic pathways in those microbes that can ferment sugars into ethanol and raise blood-alcohol levels to levels reported as legally intoxicating. - One reported patient received repeated oral capsules derived from a "super donor" fecal preparation and experienced symptom decline after about 16 months of treatment. - The research teams were based at University of California San Diego and Mass General Brigham, and authors noted that identifying specific bacteria and pathways could inform diagnosis and treatment development. Summary: The study links specific alcohol-producing gut bacteria and pathways to auto-brewery syndrome and documents a case in which fecal transplantation was followed by clinical improvement. Researchers say the findings may support clearer diagnosis and targeted therapies; wider clinical application and formal recommendations are undetermined at this time.