What is the treatment for Auto Brewery Syndrome (ABS)?

Treatment of Auto Brewery Syndrome (ABS)

The treatment of Auto Brewery Syndrome requires antifungal medications, dietary modifications, and probiotics to eliminate the fermenting organisms in the gastrointestinal tract that produce endogenous alcohol. 1, 2

Diagnosis Confirmation

• ABS is characterized by endogenous alcohol production leading to symptoms of intoxication without alcohol consumption 1
• Diagnosis is confirmed through elevated blood or breath ethanol levels after a glucose challenge test 1
• Endoscopy with intestinal secretion sampling should be performed to identify the specific fermenting organisms (fungi or bacteria) 3

First-Line Treatment

• Antifungal medications are the primary treatment when fungal organisms are identified as the cause 2, 3

  • Common causative organisms include Candida species (C. albicans, C. glabrata, C. intermedia, C. parapsilosis, C. kefyr) and Saccharomyces cerevisiae 2
  • Treatment should be guided by antifungal sensitivity testing of the identified organisms 3

• Strict carbohydrate-free diet during the initial treatment period (typically 6 weeks) 3

  • Carbohydrates serve as substrate for fermentation and must be eliminated initially 2, 4

• Probiotics to restore gut microbiome balance 2, 3

  • Single-strain probiotics can be used initially, followed by multi-strain probiotics for better competitive inhibition of fungal growth 3

Second-Line Treatment

• Antibiotics when bacterial organisms (such as Klebsiella pneumoniae) are identified as causative agents 2
  • Caution is needed as antibiotics may have contributed to the condition by altering gut microbiome 3

Monitoring and Follow-up

• Rechallenge testing for endogenous alcohol production before reintroducing carbohydrates 3
• Gradual reintroduction of carbohydrates with monitoring for symptom recurrence 4
• Long-term dietary modifications may be necessary to prevent recurrence 4

Special Considerations

• Patients with ABS face significant quality-of-life issues, including potential legal problems related to apparent intoxication 4
• Patient education about the condition and its management is crucial 4
• Careful monitoring for recurrence is necessary, especially after antibiotic treatments that may alter gut flora 3

Common Pitfalls and Caveats

• ABS is frequently underdiagnosed due to its rarity and nonspecific symptoms 5, 4
• Patients may be wrongly accused of alcohol consumption, leading to social and legal consequences 1, 4
• Prior antibiotic exposure is a common risk factor that should be identified in the patient history 3
• Treatment must be individualized based on the specific fermenting organisms identified 2, 3