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Tamama K, Kruckenberg KM, DiMartini AF. Gut and bladder fermentation syndromes: a narrative review. BMC Med 2024; 22:26. [PMID: 38246992 PMCID: PMC10801939 DOI: 10.1186/s12916-023-03241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
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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Affiliation(s)
- Kenichi Tamama
- Clinical Laboratories, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 3477 Euler Way, UPMC Presbyterian Clinical Laboratory Building, Pittsburgh, PA, 15213, USA.
| | - Katherine M Kruckenberg
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, USA
- Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrea F DiMartini
- Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Patel P, Patel D, Gutlapalli SD, Okorie IJ, Onana AE, Ugwendum D, Arrey Agbor DB, Munoh Kenne F, Otterbeck P, Nfonoyim J. The Associations of Auto-Brewery Syndrome and Diabetes Mellitus: A Literature Review and Clinical Perspective. Cureus 2023; 15:e41924. [PMID: 37588335 PMCID: PMC10425700 DOI: 10.7759/cureus.41924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/15/2023] [Indexed: 08/18/2023] Open
Abstract
Endogenous production of alcohol without the external intake of alcohol is called auto-brewery syndrome (ABS), and to get its levels to rise to a level that it has physical symptoms of alcohol intake is rare. The most common cause of ABS is the metabolism of ingested carbohydrates by intestinal microflora. This occurrence does not happen in all normal individuals but only in some high-risk individuals. Patients with diabetes mellitus (DM) have been hypothesized to be at high risk for ABS. We searched databases, such as PubMed, Medline, and PubMed Central, to search for existing literature with relevant keywords. In the finalized review, we have included 30 relevant articles. Alcohol formed in the gut gets absorbed in the bloodstream and immediately gets metabolized, so usually it does not achieve a level in blood high enough to cause symptoms. In high-risk patients, there is an increase in the level of bloodstream alcohol above a certain level, so it shows symptoms. Because there is higher blood glucose in DM, the patients have been shown to be at increased risk for developing ABS. Similarly, obesity is also a risk factor for DM, making it a high-risk condition for ABS. The most involved pathogens are Candida and Saccharomyces.
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Affiliation(s)
- Priyansh Patel
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Department of Internal Medicine, Baroda Medical College, Vadodara, IND
| | - Diya Patel
- Department of Internal Medicine, Gujarat Medical Education & Research Society, Sola, Ahmedabad, IND
| | - Sai Dheeraj Gutlapalli
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
- Department of Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ikpechukwu J Okorie
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Arnold E Onana
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Derek Ugwendum
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | | | - Foma Munoh Kenne
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Philip Otterbeck
- Department of Internal Medicine, Richmond University Medical Center, New York, USA
| | - Jay Nfonoyim
- Department of Pulmonary and Critical Care Medicine, Richmond University Medical Center, New York, USA
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3
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Xue G, Feng J, Zhang R, Du B, Sun Y, Liu S, Yan C, Liu X, Du S, Feng Y, Cui J, Gan L, Zhao H, Fan Z, Cui X, Xu Z, Fu T, Li C, Huang L, Zhang T, Wang J, Yang R, Yuan J. Three Klebsiella species as potential pathobionts generating endogenous ethanol in a clinical cohort of patients with auto-brewery syndrome: a case control study. EBioMedicine 2023; 91:104560. [PMID: 37060744 PMCID: PMC10139882 DOI: 10.1016/j.ebiom.2023.104560] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Patients with auto-brewery syndrome (ABS) become inebriated after the ingestion of an alcohol-free, high-carbohydrate diet. Our previous work has shown that high-alcohol-producing (HiAlc) Klebsiella pneumoniae can generate excessive endogenous ethanol and cause non-alcoholic fatty liver disease (NAFLD). Therefore, it is reasonable to speculate that such bacteria might play an important role in the pathogenesis of ABS. METHODS The characteristics and metabolites of the intestinal flora from a clinical cohort of patients with ABS were analysed during different stages of disease and compared to a group of healthy controls. An in vitro culture system of relevant samples was used for screening drug sensitivity and ABS-inducing factors. Rabbit intestinal and murine models were established to verify if the isolated strains could induce ABS in vivo. FINDINGS We observed intestinal dysbiosis with decreased abundance of Firmicutes and increased of Proteobacteria in patients with ABS compared with healthy controls. The abundance of the genus Klebsiella in Enterobacteriaceae was strongly associated with fluctuations of patient's blood alcohol concentration. We isolated three species of HiAlc Klebsiella from ABS patients, which were able to induce ABS in mice. Monosaccharide content was identified as a potential food-related inducing factor for alcohol production. Treatments with antibiotics, a complex probiotic preparation and a low-carbohydrate diet not only alleviated ABS, but also erased ABS relapse during the follow-up observation of one of the patients. INTERPRETATION Excessive endogenous alcohol produced by HiAlc Klebsiella species was an underlying cause of bacterial ABS. Combined prescription of appropriate antibiotics, complex probiotic preparation and a controlled diet could be sufficient for treatment of bacteria-caused ABS. FUNDING The funders are listed in the acknowledgement.
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Affiliation(s)
- Guanhua Xue
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China; Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junxia Feng
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Rui Zhang
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China; Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bing Du
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Ying Sun
- The Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Shiyu Liu
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Chao Yan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Xinjuan Liu
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Shuheng Du
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Yanling Feng
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Jinghua Cui
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Lin Gan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Hanqing Zhao
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Zheng Fan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Xiaohu Cui
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Ziying Xu
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Tongtong Fu
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Chen Li
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Lei Huang
- Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | - Ting Zhang
- Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
| | - Jing Wang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
| | - Ruifu Yang
- Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China.
| | - Jing Yuan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China; Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Paramsothy J, Gutlapalli SD, Ganipineni VDP, Okorie IJ, Ugwendum D, Piccione G, Ducey J, Kouyate G, Onana A, Emmer L, Arulthasan V, Otterbeck P, Nfonoyim J. Understanding Auto-Brewery Syndrome in 2023: A Clinical and Comprehensive Review of a Rare Medical Condition. Cureus 2023; 15:e37678. [PMID: 37206535 PMCID: PMC10189828 DOI: 10.7759/cureus.37678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/21/2023] Open
Abstract
Auto-brewery syndrome (ABS) occurs when the gastrointestinal tract produces excessive endogenous ethanol. This article examines various aspects of ABS such as its epidemiology, underlying etiology, diagnostic difficulties, management strategies, and social implications. By synthesizing the existing medical literature, we hope to identify understanding gaps, pave the way for further research, and ultimately improve detection, treatment, and awareness. The databases we used are PubMed, PubMed Central, and Google Scholar. We carefully screened all published articles from inception till date and narrowed down 24 relevant articles. We at Richmond University Medical Center and Mount Sinai are one of the leading medical centers for diagnosing and treating this rare condition in the United States.
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Affiliation(s)
- Jananthan Paramsothy
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Sai Dheeraj Gutlapalli
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
- Internal Medicine Clinical Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Vijay Durga Pradeep Ganipineni
- General Medicine, SRM Medical College Hospital and Research Center, Chennai, IND
- General Medicine, Andhra Medical College/King George Hospital, Visakhapatnam, IND
- Internal Medicine, Thomas Hospital Infirmary Health, Fairhope, USA
| | - Ikpechukwu J Okorie
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Derek Ugwendum
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - GianPaolo Piccione
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - James Ducey
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Gnama Kouyate
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Arnold Onana
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Louis Emmer
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Vaithilingam Arulthasan
- Internal Medicine, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Philip Otterbeck
- Endocrinology, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
| | - Jay Nfonoyim
- Pulmonary and Critical Care, Richmond University Medical Center Affiliated with Mount Sinai Health System and Icahn School of Medicine at Mount Sinai, Staten Island, USA
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Faulkner CS, White CM, Manatsathit W, Lamb B, Vatsalya V, McClain CJ, Jophlin LL. Positive blood phosphatidylethanol concentration is associated with unfavorable waitlist-related outcomes for patients medically appropriate for liver transplantation. Alcohol Res 2022; 46:581-588. [PMID: 35102553 PMCID: PMC9150771 DOI: 10.1111/acer.14786] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Excessive alcohol use is a leading etiology of liver disease and indication for liver transplantation. Accurate measurement of alcohol use remains a challenge in the management of patients in the pre-, peri-, and post-liver transplant settings. Blood 16:0-18:1 phosphatidylethanol (PEth) concentration is a sensitive and specific biomarker of binge and moderate, chronic alcohol use. As PEth has the longest detection window of available blood-based direct alcohol biomarkers for moderate to heavy drinking, it shows promise as an indicator of patterns and chronicity of drinking. However, the utility of PEth in clinical liver transplantation is understudied. This study examines the association of PEth results with liver transplantation waitlist-focused patient outcomes. METHODS Retrospective data for all patients tested for PEth for a one-year period at a tertiary care medical center with an active liver transplantation program were abstracted. Indications for PEth testing, liver transplantation waitlist-related outcomes (e.g., listing and delisting) following testing and associations of PEth results with other parameters were analyzed. RESULTS Over a one-year period, 153 PEth tests were performed on 109 individuals. The most frequent indications for PEth testing were as an objective indicator of alcohol use patterns (86.3%) and to assess alcohol as a putative etiology of liver injury (13.7%). Of the 109 patients, 56 were medically appropriate for liver transplantation. Medically acceptable candidates with unfavorable transplantation waitlist-related outcomes (delisting, deferment of transplant evaluation, deferment of listing until completion of recommended alcohol rehabilitation, and being deemed not a transplant candidate) were at least 3.41 times more likely to have a positive PEth test than those with favorable transplantation waitlist-related outcomes (odds ratio 3.41, confidence interval 3.41 to ∞, p = 0.001). CONCLUSION This single-center study reporting a comprehensive account of PEth utilization at a liver transplant center demonstrates that liver transplantation waitlist-related outcomes are associated with PEth test results. Patients with positive PEth tests were more likely to have unfavorable transplant waitlist-related outcomes. PEth testing has not been validated as a predictor of relapse to drinking in post-transplant patients and because its utility in the pre-transplant setting is unclear its use could lead to disparities in the selection of patients for liver transplantation.
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Affiliation(s)
- Claire S Faulkner
- Department of Medicine, University of Arizona, College of Medicine, Phoenix, Arizona, USA.,Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Collin M White
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA
| | - Wuttiporn Manatsathit
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Bernadette Lamb
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Vatsalya Vatsalya
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA.,University of Louisville Alcohol Research Center, University of Louisville, Louisville, Kentucky, USA.,Robley Rex VA Medical Center, Louisville, Kentucky, USA.,Hepatobiology and Toxicology Program, University of Louisville, Louisville, Kentucky, USA
| | - Craig J McClain
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA.,University of Louisville Alcohol Research Center, University of Louisville, Louisville, Kentucky, USA.,Robley Rex VA Medical Center, Louisville, Kentucky, USA.,Hepatobiology and Toxicology Program, University of Louisville, Louisville, Kentucky, USA.,Department of Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky, USA
| | - Loretta L Jophlin
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA.,University of Louisville Alcohol Research Center, University of Louisville, Louisville, Kentucky, USA.,Hepatobiology and Toxicology Program, University of Louisville, Louisville, Kentucky, USA
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6
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Dinis-Oliveira RJ. The Auto-Brewery Syndrome: A Perfect Metabolic "Storm" with Clinical and Forensic Implications. J Clin Med 2021; 10:4637. [PMID: 34682761 PMCID: PMC8537665 DOI: 10.3390/jcm10204637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/29/2022] Open
Abstract
Auto-brewery syndrome (ABS) is a rare, unstudied, unknown, and underreported phenomenon in modern medicine. Patients with this syndrome become inebriated and may suffer the medical and social implications of alcoholism, including arrest for inebriated driving. The pathophysiology of ABS is reportedly due to a fungal type dysbiosis of the gut that ferments some carbohydrates into ethanol and may mimic a food allergy or intolerance. This syndrome should be considered in patients with chronic obstruction or hypomotility presenting with elevated breath and blood alcohol concentrations, especially after a high carbohydrate intake. A glucose challenge test should be performed as the confirmatory test. Treatment typically includes antifungal drugs combined with changes in lifestyle and nutrition. Additional studies are particularly needed on the human microbiome to shed light on how imbalances of commensal bacteria in the gut allow yeast to colonize on a pathological level.
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Affiliation(s)
- Ricardo Jorge Dinis-Oliveira
- TOXRUN—Toxicology Research Unit, University Institute of Health Sciences, Advanced Polytechnic and University Cooperative (CESPU), CRL, 4585-116 Gandra, Portugal; or or ; Tel.: +351-224-157-216
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira nº 228, 4050-313 Porto, Portugal
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7
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Bayoumy AB, Mulder CJJ, Mol JJ, Tushuizen ME. Gut fermentation syndrome: A systematic review of case reports. United European Gastroenterol J 2021; 9:332-342. [PMID: 33887125 PMCID: PMC8259373 DOI: 10.1002/ueg2.12062] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/02/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The gut fermentation syndrome (GFS), also known as the endogenous alcohol fermentation syndrome or auto brewery syndrome, is a rare and underdiagnosed medical condition where consumed carbohydrates are converted to alcohol by the microbiota in the gastrointestinal or urinary tract. The symptoms of GFS can have severe impact on patients' wellbeing and can have social and legal consequences. Unfortunately, not much is reported about GFS. The aim of this systematic review was to assess the evidence for GFS, causal micro-organisms, diagnostics, and possible treatments. METHODS A protocol was developed prior to initiation of the systematic review (PROSPERO 207182). We performed a literature search for clinical studies on 1 September 2020 using PubMed and Embase. We included all clinical studies, including case reports that described the GFS. RESULTS In total, 17 case reports were included, consisting of 20 patients diagnosed with GFS. The species that caused the GFS included Klebsiella pneumoniae, Candida albicans, C. glabrata, Saccharomyces cerevisiae, C. intermedia, C. parapsilosis, and C. kefyr. CONCLUSIONS GFS is a rare but underdiagnosed disease in daily practice. The disease is mostly reported by Saccharomyces and Candida genera, and some cases were previously treated with antibiotics. Studies in Nonalcoholic Fatty Liver disease suggest a bacterial origin of endogenous alcohol-production, which might also be causal micro-organisms in GFS. Current treatments for GFS include antibiotics, antifungal medication, low carbohydrate diet, and probiotics. There might be a potential role of fecal microbiota transplant in the treatment of GFS.
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Affiliation(s)
- Ahmed B Bayoumy
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, The Netherlands
| | - Chris J J Mulder
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jaap J Mol
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
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8
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Martin M, Alvarez JC. Production endogène d’éthanol chez le sujet vivant : le syndrome d’auto-brasserie. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2020. [DOI: 10.1016/j.toxac.2020.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Tameez Ud Din A, Alam F, Tameez-Ud-Din A, Chaudhary FMD. Auto-Brewery Syndrome: A Clinical Dilemma. Cureus 2020; 12:e10983. [PMID: 33209539 PMCID: PMC7667719 DOI: 10.7759/cureus.10983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
Auto-brewery syndrome (ABS), also known as gut fermentation syndrome, is a very rare disorder. It is characterized by the endogenous production of alcohol. It typically presents with the signs of alcohol intoxication, such as staggering gait, slurred speech, gastrointestinal distress, and state of confusion. Due to the nonspecific symptoms, it is necessary to rule out other etiologies before reaching a diagnosis of ABS. The confirmatory test for this syndrome is the raised levels of blood or breath ethanol after a glucose challenge test. The management includes the use of antifungal drugs and avoidance of a carbohydrate-rich diet. In this review, we summarize the etiology, clinical presentation, diagnostic tests, management, and medicolegal aspects of ABS.
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Affiliation(s)
| | - Faran Alam
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Farooq Mohyud Din Chaudhary
- Gastroenterology, Buch International Hospital, Multan, PAK
- Gastroenterology, Mohyud Din Clinic, Multan, PAK
- Gastroenterology, Nishtar Hospital, Multan, PAK
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10
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Martin M, Alvarez JC. Ethanolémie positive sans consommation d’alcool chez le sujet vivant : le syndrome d’auto-brasserie. Conséquences cliniques et médico-judiciaires. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2020. [DOI: 10.1016/j.toxac.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Yuan J, Chen C, Cui J, Lu J, Yan C, Wei X, Zhao X, Li N, Li S, Xue G, Cheng W, Li B, Li H, Lin W, Tian C, Zhao J, Han J, An D, Zhang Q, Wei H, Zheng M, Ma X, Li W, Chen X, Zhang Z, Zeng H, Ying S, Wu J, Yang R, Liu D. Fatty Liver Disease Caused by High-Alcohol-Producing Klebsiella pneumoniae. Cell Metab 2019; 30:675-688.e7. [PMID: 31543403 DOI: 10.1016/j.cmet.2019.08.018] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/11/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023]
Abstract
The underlying etiology of nonalcoholic fatty liver disease (NAFLD) is believed to be quite varied. Changes in the gut microbiota have been investigated and are believed to contribute to at least some cases of the disease, though a causal relationship remains unclear. Here, we show that high-alcohol-producing Klebsiella pneumoniae (HiAlc Kpn) is associated with up to 60% of individuals with NAFLD in a Chinese cohort. Transfer of clinical isolates of HiAlc Kpn by oral gavage into mice induced NAFLD. Likewise, fecal microbiota transplant (FMT) into mice using a HiAlc-Kpn-strain-containing microbiota isolated from an individual with NASH induced NAFLD. However, selective elimination of the HiAlc Kpn strain before FMT prevented NAFLD in the recipient mice. These results suggest that at least in some cases of NAFLD an alteration in the gut microbiome drives the condition due to excess endogenous alcohol production.
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Affiliation(s)
- Jing Yuan
- Capital Institute of Pediatrics, Beijing 100020, China; Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China.
| | - Chen Chen
- Beijing key laboratory of emerging infectious diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Jinghua Cui
- Capital Institute of Pediatrics, Beijing 100020, China
| | - Jing Lu
- Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - Chao Yan
- Capital Institute of Pediatrics, Beijing 100020, China
| | - Xiao Wei
- Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - Xiangna Zhao
- Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - NanNan Li
- Capital Institute of Pediatrics, Beijing 100020, China
| | - Shaoli Li
- Capital Institute of Pediatrics, Beijing 100020, China
| | - Guanhua Xue
- Capital Institute of Pediatrics, Beijing 100020, China
| | - Weiwei Cheng
- Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - Boxing Li
- Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - Huan Li
- Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - Weishi Lin
- Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - Changyu Tian
- Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - Jiangtao Zhao
- Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - Juqiang Han
- Institute of Hepatology, PLA Army General Hospital, Beijing 100700, China
| | - Daizhi An
- Chinese PLA Center for Disease Control and Prevention, Beijing 100071, China
| | - Qiong Zhang
- Beijing key laboratory of emerging infectious diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Hong Wei
- College of Animal Sciences and Technology, Huazhong Agricultural University, Wuhan 430070, China
| | - Minghua Zheng
- NAFLD Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China
| | - Xuejun Ma
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Wei Li
- Computational Virology Group, Center for Bacteria and Virus Resources and Application, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, China; University of Chinese Academy of Sciences, Beijing 101408, China; Institue of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
| | - Xiao Chen
- Capital Institute of Pediatrics, Beijing 100020, China
| | - Zheng Zhang
- Capital Institute of Pediatrics, Beijing 100020, China
| | - Hui Zeng
- Beijing key laboratory of emerging infectious diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Sun Ying
- Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing 100069, China
| | - JianXin Wu
- Capital Institute of Pediatrics, Beijing 100020, China
| | - Ruifu Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China.
| | - Di Liu
- Computational Virology Group, Center for Bacteria and Virus Resources and Application, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, China; University of Chinese Academy of Sciences, Beijing 101408, China.
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12
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Akhavan BJ, Ostrosky-Zeichner L, Thomas EJ. Drunk Without Drinking: A Case of Auto-Brewery Syndrome. ACG Case Rep J 2019; 6:e00208. [PMID: 31750376 PMCID: PMC6831150 DOI: 10.14309/crj.0000000000000208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023] Open
Abstract
Information on auto-brewery syndrome is limited in the medical literature. This rare syndrome occurs when yeast overgrowth leads to ethanol fermentation in the gut. We present a patient presenting with symptoms of alcohol intoxication with objective laboratory data of elevated blood ethanol levels without a history of alcohol consumption. We reviewed the literature and have discussed the current diagnostic and therapeutic options.
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Affiliation(s)
- Bobak J. Akhavan
- Division of General Internal Medicine, Department of Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Eric J. Thomas
- Division of General Internal Medicine, Department of Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
- The University of Texas at Houston, Memorial Hermann Center of Healthcare Quality and Safety, Houston, TX
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13
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Malik F, Wickremesinghe P, Saverimuttu J. Case report and literature review of auto-brewery syndrome: probably an underdiagnosed medical condition. BMJ Open Gastroenterol 2019; 6:e000325. [PMID: 31423320 PMCID: PMC6688673 DOI: 10.1136/bmjgast-2019-000325] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/21/2019] [Accepted: 07/23/2019] [Indexed: 01/03/2023] Open
Abstract
Auto-brewery syndrome (ABS), also known as gut fermentation syndrome, is a rarely diagnosed medical condition in which the ingestion of carbohydrates results in endogenous alcohol production. The patient in this case report had fungal yeast forms in the upper small bowel and cecum, which likely fermented carbohydrates to alcohol. Treatment with antifungal agents allowed subsequent ingestion of carbohydrates without symptoms. He had been exposed to a prolonged course of antibiotics before this occurred. We postulate that the antibiotic altered his gut microbiome, allowing fungal growth. This diagnosis should be considered in any patient with positive manifestations of alcohol toxicity who denies alcohol ingestion. The aim of this case report was confirmation and treatment of ABS using a standardised carbohydrate challenge test followed by upper and lower endoscopy to obtain intestinal secretions to detect fungal growth. These fungi were speciated and antifungal sensitivity performed. This allowed the use of appropriate therapy. The patient was kept on a carbohydrate-free diet during the initial 6-week period of therapy. A single-strain probiotic for competitive inhibition of fungal growth was given to the patient. This probiotic was later replaced by a multistrain bacterial probiotic hoping that the multiple bacteria would inhibit fungi better than a single-strain. The beneficial role of probiotics in this condition has not been studied. The patient was rechallenged for endogenous alcohol production prior to reintroducing carbohydrates in his diet.
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Affiliation(s)
- Fahad Malik
- Internal Medicine, Richmond University Medical Center, Staten Island, New York, USA
| | | | - Jessie Saverimuttu
- Internal Medicine, Richmond University Medical Center, Staten Island, New York, USA
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Cordell BJ, Kanodia A, Miller GK. Case-Control Research Study of Auto-Brewery Syndrome. Glob Adv Health Med 2019; 8:2164956119837566. [PMID: 31037230 PMCID: PMC6475837 DOI: 10.1177/2164956119837566] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/20/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Auto-brewery syndrome (ABS), also known as Gut Fermentation Syndrome and Endogenous Ethanol Fermentation, is afflicting people worldwide, but little is known about ABS patients' demographics, health history, lifestyle factors, and diet. METHOD We conducted a broad-based case-control survey study on 52 patients known to have a diagnosis of ABS and their household members. The research compares the symptomatic group (N = 28) to the asymptomatic group (N = 18) regarding lifestyle and health, diet, and medical history. RESULTS With a response rate of 88% and using rank-sum tests, the data demonstrate that patients with ABS have significant differences compared to people without ABS in lower quality bowel movements (P = .048), more frequent bowel movements (P = .038), more reports of malodorous breath (P = .0001), and self-classify as having poorer health (P = .009). Furthermore, participants with ABS consume more water (P = .038), consume less tea and coffee (P = .033), eat fewer dairy products (P = .0185), eat less candy (P = .032), eat out less and rely on food prepared at home (P = .043), have more aversion to starch (P = .008), and have more food sensitivities (P = .043) than the group without ABS. The ABS group also reports more diarrhea (P = .048), higher amounts of yeast in their gastrointestinal tract (P = .015), and using acne medication for a longer time (P = .037) than the control group. CONCLUSION Patients with ABS have significant differences in their lifestyle and health, diet, and medical history compared to non-ABS participants and these differences warrant further research.
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Affiliation(s)
| | - Anup Kanodia
- Wexner Medical Center, Ohio State University, Columbus, Ohio
| | - Gregory K Miller
- East Texas Statistical Services, Stephen F. Austin State University, Nacogdoches, Texas
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15
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Sanctuary MR, Kain JN, Chen SY, Kalanetra K, Lemay DG, Rose DR, Yang HT, Tancredi DJ, German JB, Slupsky CM, Ashwood P, Mills DA, Smilowitz JT, Angkustsiri K. Pilot study of probiotic/colostrum supplementation on gut function in children with autism and gastrointestinal symptoms. PLoS One 2019; 14:e0210064. [PMID: 30625189 PMCID: PMC6326569 DOI: 10.1371/journal.pone.0210064] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 12/16/2018] [Indexed: 12/18/2022] Open
Abstract
Over half of all children with autism spectrum disorders (ASD) have gastrointestinal (GI) co-morbidities including chronic constipation, diarrhea, and irritable bowel syndrome. The severity of these symptoms has been correlated with the degree of GI microbial dysbiosis. The study objective was to assess tolerability of a probiotic (Bifidobacterium infantis) in combination with a bovine colostrum product (BCP) as a source of prebiotic oligosaccharides and to evaluate GI, microbiome and immune factors in children with ASD and GI co-morbidities. This pilot study is a randomized, double blind, controlled trial of combination treatment (BCP + B. infantis) vs. BCP alone in a cross-over study in children ages 2-11 with ASD and GI co-morbidities (n = 8). This 12-week study included 5 weeks of probiotic-prebiotic supplementation, followed by a two-week washout period, and 5 weeks of prebiotic only supplementation. The primary outcome of tolerability was assessed using validated questionnaires of GI function and atypical behaviors, along with side effects. Results suggest that the combination treatment is well-tolerated in this cohort. The most common side effect was mild gassiness. Some participants on both treatments saw a reduction in the frequency of certain GI symptoms, as well as reduced occurrence of particular aberrant behaviors. Improvement may be explained by a reduction in IL-13 and TNF-α production in some participants. Although limited conclusions can be drawn from this small pilot study, the results support the need for further research into the efficacy of these treatments.
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Affiliation(s)
- Megan R. Sanctuary
- Department of Nutrition, University of California, Davis, California, United States of America
| | - Jennifer N. Kain
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, California, United States of America
| | - Shin Yu Chen
- Department of Food Science and Technology, University of California, Davis, California, United States of America
| | - Karen Kalanetra
- Department of Food Science and Technology, University of California, Davis, California, United States of America
| | - Danielle G. Lemay
- USDA ARS Western Human Nutrition Research Center, Davis, California, United States of America
- Genome Center, University of California, Davis, California, United States of America
| | - Destanie R. Rose
- MIND Institute, University of California Davis, Sacramento, California, United States of America
| | - Houa T. Yang
- MIND Institute, University of California Davis, Sacramento, California, United States of America
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California School of Medicine, Sacramento, California, United States of America
| | - J. Bruce German
- Department of Food Science and Technology, University of California, Davis, California, United States of America
- Foods for Health Institute, University of California, Davis, California, United States of America
| | - Carolyn M. Slupsky
- Department of Nutrition, University of California, Davis, California, United States of America
- Department of Food Science and Technology, University of California, Davis, California, United States of America
| | - Paul Ashwood
- MIND Institute, University of California Davis, Sacramento, California, United States of America
| | - David A. Mills
- Department of Food Science and Technology, University of California, Davis, California, United States of America
| | - Jennifer T. Smilowitz
- Department of Food Science and Technology, University of California, Davis, California, United States of America
- Foods for Health Institute, University of California, Davis, California, United States of America
| | - Kathleen Angkustsiri
- MIND Institute, University of California Davis, Sacramento, California, United States of America
- Department of Pediatrics, University of California School of Medicine, Sacramento, California, United States of America
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16
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Bos LDJ, Meinardi S, Blake D, Whiteson K. Bacteria in the airways of patients with cystic fibrosis are genetically capable of producing VOCs in breath. J Breath Res 2016; 10:047103. [DOI: 10.1088/1752-7163/10/4/047103] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Welch BT, Coelho Prabhu N, Walkoff L, Trenkner SW. Auto-brewery Syndrome in the Setting of Long-standing Crohn's Disease: A Case Report and Review of the Literature. J Crohns Colitis 2016; 10:1448-1450. [PMID: 27161390 DOI: 10.1093/ecco-jcc/jjw098] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 05/04/2016] [Indexed: 02/08/2023]
Abstract
CLINICAL BACKGROUND A 71-year-old male with 50-year history of Crohn's disease was evaluated for acute onset of dizziness and slurred speech. Blood ethanol levels were elevated despite abstinence from alcohol for over 30 years. CT enterography demonstrated massive dilation of the small bowel with anastomotic stricture. DISCUSSION Auto-brewery syndrome may be considered in a patient with chronic obstruction or hypomotility presenting with elevated serum ethanol levels in the setting of high carbohydrate intake. Although treatment algorithms lack validation, judicious use of antibiotic therapy, carbohydrate control, and short courses of antifungal therapy have all been reported in the literature. Importantly, clinical consideration of 'auto-brewery' should be undertaken with substantial caution, given the lack of validated mechanisms linking endogenous ethanol production to peripheral blood ethanol.
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Affiliation(s)
- B T Welch
- Mayo Clinic Department of Radiology, Rochester, MN, USA
| | - N Coelho Prabhu
- Mayo Clinic Department of Gastroenterology and Hepatology, Rochester, MN, USA
| | - L Walkoff
- Mayo Clinic Department of Radiology, Rochester, MN, USA
| | - S W Trenkner
- Mayo Clinic Department of Radiology, Rochester, MN, USA
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18
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Hafez EM, Hamad MA, Fouad M, Abdel-Lateff A. Auto-brewery syndrome: Ethanol pseudo-toxicity in diabetic and hepatic patients. Hum Exp Toxicol 2016; 36:445-450. [PMID: 27492480 DOI: 10.1177/0960327116661400] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endogenous alcohol has been applied for spontaneous ethanol production via different metabolic pathways of the human body. Auto-brewery syndrome describes the patients with alcohol intoxication after ingesting carbohydrate-rich meals. The main objective of this study is to investigate the effect of diabetes mellitus (DM), liver cirrhosis (LC) and presence of both (DM and LC) on blood alcohol concentration (BAC) especially after carbohydrate ingestion. BAC has been measured by headspace gas chromatography-mass spectrometry in three groups of humans namely control, DM, LC and both (DM and LC) groups. The results showed that BAC in control group was 0.01-.3 mg/dL with mean 0.3 ± 0.41 mg/dL. In patients with DM, BAC is significantly higher than that of control group 4.85 ± 3.96 mg/dL. In patients with LC, BAC was 3.45 ± 2.65 mg/dL. In patients with both DM and LC, BAC increases to reach 10.88 ± 5.36 mg/dL. Endogenous ethanol production appears to increase in DM and LC. Also, it increased much more in patients with both diseases, but it did not reach toxic levels. On comparing BAC and blood glucose level in each group, all groups show insignificant correlations ( p > 0.05).
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Affiliation(s)
- E M Hafez
- 1 Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Minia University, Minia, Egypt
| | - M A Hamad
- 1 Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Minia University, Minia, Egypt
| | - M Fouad
- 2 Department of Tropical medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - A Abdel-Lateff
- 3 Department of Pharmacognosy, Faculty of Pharmacy, Minia University, Minia, Egypt.,4 Department of Natural Products and Alternative Medicine, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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19
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de Medeiros IC, de Lima JG. Is nonalcoholic fatty liver disease an endogenous alcoholic fatty liver disease? – A mechanistic hypothesis. Med Hypotheses 2015; 85:148-52. [DOI: 10.1016/j.mehy.2015.04.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 04/11/2015] [Accepted: 04/21/2015] [Indexed: 02/07/2023]
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20
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Cordell B, McCarthy J. A Case Study of Gut Fermentation Syndrome (Auto-Brewery) with <i>Saccharomyces cerevisiae</i> as the Causative Organism. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ijcm.2013.47054] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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21
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Denouement. Pediatr Infect Dis J 2012; 31:429-30. [PMID: 22418660 DOI: 10.1097/inf.0b013e3182416838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Zelner I, Hutson JR, Kapur BM, Feig DS, Koren G. False-Positive Meconium Test Results for Fatty Acid Ethyl Esters Secondary to Delayed Sample Collection. Alcohol Clin Exp Res 2012; 36:1497-506. [DOI: 10.1111/j.1530-0277.2012.01763.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 01/13/2012] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Denice S. Feig
- Division of Endocrinology; Department of Medicine; Mount Sinai Hospital; University of Toronto; Toronto; Ontario; Canada
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23
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Simic M, Ajdukovic N, Veselinovic I, Mitrovic M, Djurendic-Brenesel M. Endogenous ethanol production in patients with Diabetes Mellitus as a medicolegal problem. Forensic Sci Int 2012; 216:97-100. [DOI: 10.1016/j.forsciint.2011.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 08/09/2011] [Accepted: 09/01/2011] [Indexed: 10/17/2022]
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24
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Hernández-Tobías A, Julián-Sánchez A, Piña E, Riveros-Rosas H. Natural alcohol exposure: Is ethanol the main substrate for alcohol dehydrogenases in animals? Chem Biol Interact 2011; 191:14-25. [DOI: 10.1016/j.cbi.2011.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 02/01/2011] [Accepted: 02/01/2011] [Indexed: 01/30/2023]
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25
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Lee J, Ngo J, Blake D, Meinardi S, Pontello AM, Newcomb R, Galassetti PR. Improved predictive models for plasma glucose estimation from multi-linear regression analysis of exhaled volatile organic compounds. J Appl Physiol (1985) 2009; 107:155-60. [PMID: 19423833 DOI: 10.1152/japplphysiol.91657.2008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Exhaled volatile organic compounds (VOCs) represent ideal biomarkers of endogenous metabolism and could be used to noninvasively measure circulating variables, including plasma glucose. We previously demonstrated that hyperglycemia in different metabolic settings (glucose ingestion in pediatric Type 1 diabetes) is paralleled by changes in exhaled ethanol, acetone, and methyl nitrate. In this study we integrated these gas changes along with three additional VOCs (2 forms of xylene and ethylbenzene) into multi-linear regression models to predict plasma glucose profiles in 10 healthy young adults, during the 2 h following an intravenous glucose bolus (matched samples of blood, exhaled and room air were collected at 12 separate time points). The four-gas model with highest predictive accuracy estimated plasma glucose in each subject with a mean R value of 0.91 (range 0.70-0.98); increasing the number of VOCs in the model only marginally improved predictions (average R with best 5-gas model = 0.93; with 6-gas model = 0.95). While practical development of this methodology into clinically usable devices will require optimization of predictive algorithms on large-scale populations, our data prove the feasibility and potential accuracy of breath-based glucose testing.
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Affiliation(s)
- Jane Lee
- Department of Pharmacology, University of California, Irvine, Orange, California 92868, USA
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26
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Spinucci G, Guidetti M, Lanzoni E, Pironi L. Endogenous ethanol production in a patient with chronic intestinal pseudo-obstruction and small intestinal bacterial overgrowth. Eur J Gastroenterol Hepatol 2006; 18:799-802. [PMID: 16772842 DOI: 10.1097/01.meg.0000223906.55245.61] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The case of the gastrointestinal production of ethanol from Candida albicans and Saccharomyces cerevisiae in a Caucasian man with chronic intestinal pseudo-obstruction is reported. The patient, who declared to have always abstained from alcohol, was hospitalized for abdominal pain, belching and mental confusion. The laboratory findings showed the presence of ethanol in the blood. Gastric juice and faecal microbiological cultures were positive for C. albicans and S. cerevisiae. At home, he was on oral antibiotic therapy with amoxicillin plus clavulanic acid for a small bowel bacterial overgrowth, associated with a simple sugar-rich diet. Twenty-four hours after stopping both the antibiotic therapy and the simple sugar-rich diet, the blood ethanol disappeared. A provocative test, performed by giving amoxicillin plus clavulanic acid associated with the simple sugar-rich diet was followed by the reappearance of ethanol in the blood. A review of the literature is reported.
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Affiliation(s)
- Giulio Spinucci
- Centre for Chronic Intestinal Failure, Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
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27
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Dibaise JK, Young RJ, Vanderhoof JA. Enteric microbial flora, bacterial overgrowth, and short-bowel syndrome. Clin Gastroenterol Hepatol 2006; 4:11-20. [PMID: 16431299 DOI: 10.1016/j.cgh.2005.10.020] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Small intestinal bacterial overgrowth (SIBO) occurs commonly in short-bowel syndrome (SBS) and, in some instances, may result in significant problems. SIBO is characterized by a variety of signs and symptoms resulting from nutrient malabsorption caused by an increased number and/or type of bacteria in the small intestine. The anatomic and physiologic changes that occur in SBS together with medications commonly used in these patients facilitate the development of SIBO. Because many aspects related to SIBO in the SBS population remain poorly understood, it was our aim to review the current understanding of the gut flora and issues related to SIBO occurring in SBS.
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Affiliation(s)
- John K Dibaise
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
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28
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Galassetti PR, Novak B, Nemet D, Rose-Gottron C, Cooper DM, Meinardi S, Newcomb R, Zaldivar F, Blake DR. Breath ethanol and acetone as indicators of serum glucose levels: an initial report. Diabetes Technol Ther 2005; 7:115-23. [PMID: 15738709 DOI: 10.1089/dia.2005.7.115] [Citation(s) in RCA: 156] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Many volatile organic compounds are present in exhaled breath and may represent by-products of endogenous biological processes. Ethanol is produced via alcoholic fermentation of glucose by gut bacteria and yeast, while acetone derives from oxidations of free fatty acids, influenced by glucose metabolism. We hypothesized that the integrated analysis of breath ethanol and acetone would provide a good approximation of the blood glucose profile during a glucose load. METHODS We collected simultaneous exhaled breath gas, ambient air, and serum glucose and insulin samples from 10 healthy volunteers at baseline and during an oral glucose tolerance test (OGTT) (ingestion of 75 g of glucose followed by 120 min of sampling). Gas samples were analyzed by gas chromatography/mass spectrometry. RESULTS Mean glucose values displayed a typical OGTT pattern (rapid increase, peak values at 30-60 min, and gradual return to near baseline by 120 min). Breath ethanol displayed a similar pattern early in the test, with peak values at 30 min; this was followed by a fast return to basal levels by 60 min. Breath acetone decreased progressively below basal levels, with lowest readings obtained at 120 min. A multiple regression analysis of glucose, ethanol, and acetone was used to estimate glucose profiles that correlated with measured glucose values with an average individual correlation coefficient of 0.70, and not lower than 0.41 in any subject. CONCLUSION The integrated analysis of multiple exhaled gases may serve as a marker of blood glucose levels. Further studies are needed to assess the usefulness of this method in different populations.
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Affiliation(s)
- Pietro R Galassetti
- Center for the Study of Health Effects of Exercise in Children, University of California, Irvine, College of Medicine, Orange, California 92868, USA.
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Abstract
The management of patients with intestinal failure due to short bowel syndrome is complex, requiring a comprehensive approach that frequently necessitates long-term, if not life-long, use of parenteral nutrition. Despite tremendous advances in the provision of parenteral nutrition over the past three decades, which have allowed significant improvements in the survival and quality of life of these patients, this mode of nutritional support carries with it significant risks to the patient, is very costly, and ultimately, does not attempt to improve the function of the remaining bowel. Intestinal rehabilitation refers to the process of restoring enteral autonomy, and thus, allowing freedom from parenteral nutrition, usually by means of dietary, medical, and occasionally, surgical strategies. While recent investigations have focused on the use of trophic substances to increase the absorptive function of the remaining gut, whether intestinal rehabilitation occurs as a consequence of enhanced bowel adaptation or is simply a result of an optimized, comprehensive approach to the care of these patients remains unclear. In Part 1 of this review, we provided an overview of short bowel syndrome and pathophysiological considerations related to the remaining bowel anatomy in these patients. We also reviewed intestinal adaptation and factors that may enhance the adaptive process, focusing on evidence derived from animal studies. In Part 2, relevant data on the development of intestinal adaptation in humans are reviewed as is the general management of short bowel syndrome. Lastly, the potential benefits of a multidisciplinary intestinal rehabilitation program in the care of these patients are also discussed.
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Affiliation(s)
- John K DiBaise
- Department of Internal Medicine, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE 68198-2000, USA
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30
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Vanderhoof JA, Young RJ. Enteral and parenteral nutrition in the care of patients with short-bowel syndrome. Best Pract Res Clin Gastroenterol 2003; 17:997-1015. [PMID: 14642862 DOI: 10.1016/s1521-6918(03)00082-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Short-bowel syndrome is a challenging entity for the gastroenterologist, requiring integration of medical, nutritional, surgical and psychological therapies. Treatment must be based on the patient's age, remaining gastrointestinal anatomy, baseline nutritional status and underlying general health as well as the numerous complications which may arise. This chapter reviews physiological alterations that occur with short-bowel syndrome and how therapies can be tailored to most adequately meet the needs of these patients. Emphasis on early stages of therapy to enhance intestinal adaptation is focused on as management during this time has a significant impact on the long-term outcome of these patients.
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Affiliation(s)
- Jon A Vanderhoof
- Chief Section of Pediatric Gastroenterology and Nutrition, University of Nebraska Medical Center, 985160 Nebraska Medical Center, Omaha, NE 68198-5160, USA.
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31
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Logan BK, Jones AW. Endogenous ethanol production in a child with short gut syndrome. J Pediatr Gastroenterol Nutr 2003; 36:419-20; author's reply 420-1. [PMID: 12604989 DOI: 10.1097/00005176-200303000-00026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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