Treatment of Auto Brewery Syndrome (ABS)
The treatment of Auto Brewery Syndrome requires antifungal medications, dietary modifications, and probiotics to eliminate the fermenting organisms and prevent recurrence. 1, 2
Diagnosis Confirmation
- ABS is characterized by endogenous alcohol production resulting in symptoms of alcohol intoxication without alcohol consumption 1
- Confirmatory testing includes elevated blood or breath ethanol levels after a glucose challenge test 1
- Endoscopy with intestinal secretion sampling is recommended to identify the specific fermenting organisms (typically fungi) for targeted treatment 3
Primary Treatment Components
Antifungal Therapy
- First-line treatment includes antifungal medications to eliminate the fungal overgrowth responsible for carbohydrate fermentation 2, 3
- Treatment duration typically lasts at least 6 weeks, with medication selection based on fungal speciation and sensitivity testing 3
- Common causative organisms include Candida species (C. albicans, C. glabrata, C. intermedia, C. parapsilosis, and C. kefyr) and Saccharomyces cerevisiae 2
Dietary Modifications
- A carbohydrate-restricted diet is essential during initial treatment to prevent substrate availability for fermentation 3, 4
- Complete carbohydrate elimination is recommended during the first 6 weeks of antifungal therapy 3
- Gradual reintroduction of carbohydrates should only occur after successful treatment and rechallenge testing confirms resolution 3
Probiotic Supplementation
- Probiotics are used to restore normal gut microbiome and competitively inhibit fungal growth 3
- Multi-strain bacterial probiotics may be more effective than single-strain options for inhibiting fungal overgrowth 3, 4
Special Considerations
- Many ABS cases develop following antibiotic use, which disrupts the normal gut microbiome and allows fungal overgrowth 3, 5
- In some cases, bacterial species like Klebsiella pneumoniae have been identified as causative organisms, which may require antibiotic treatment rather than antifungals 2
- Fecal microbiota transplantation may have potential as a treatment option in refractory cases 2
Monitoring and Follow-up
- Rechallenge testing should be performed prior to reintroducing carbohydrates to confirm resolution of endogenous alcohol production 3
- Long-term dietary modifications and probiotic maintenance may be necessary to prevent recurrence 4
- Ongoing monitoring for symptoms of intoxication after carbohydrate consumption is recommended 5, 4
Common Pitfalls and Caveats
- ABS is frequently underdiagnosed due to its rarity and nonspecific symptoms 5, 4
- Patients may face social stigma and legal consequences (e.g., DUI charges) due to unexplained intoxication 4
- Failure to identify and treat the specific causative organisms may result in treatment failure 3
- Without proper treatment, ABS can significantly impact physical health, social functioning, and quality of life 4