A0255 - A Case Series of 25 Auto-Brewery Syndrome Patients: A Single Community Hospital Experience

Award: Presidential Poster Award

James A. Ducey, MD¹, Fahad Malik, MD², Prasanna Wickremesinghe, MD^1
1Richmond University Medical Center, Staten Island, NY; ²United Health Services- Wilson Hospital, Binghamton, NY

Introduction: Auto-brewery syndrome (ABS) is a rare condition where ingested carbohydrate is converted to alcohol by enteric fungi; a diagnosis often discounted by medical personnel. The goal of our study was to confirm or refute the diagnosis of ABS with a systematic investigative and treatment plan. Initial success caused patients from across the country to seek our center.

Methods: Criteria for evaluation were as follows: alcohol abstinence, positive breathalyzer without alcohol ingestion, concomitant elevated blood alcohol level, corroboration of abstinence from family member or close friend, and prior medical evaluation for an alternative cause of symptoms.

If patient met criteria, they underwent endoscopic evaluation for collection of gastrointestinal secretions. Collected samples were sent for culture with sensitivities. After endoscopy, patient submitted to a Carbohydrate Challenge Test (CCT), which involved breathalyzer as well as initial serum glucose and ethanol levels. Then ingestion of 200g of glucose, followed by serial monitoring of breathalyzer, serum glucose and serum ethanol levels for 8 hours.

Then patients started on antifungal therapy, carbohydrate free diet for 6 weeks and serial breathalyzer monitoring, followed by reintroduction of carbohydrates to diet. If breathalyzer turned positive, then antifungal regimen was adjusted based on cultures.

Results: The 25 patients included 20 males and 5 females, age range 20-63(41.8) years. All patients had antibiotic exposure prior to symptoms. 16(64%) had a positive CCT. 11(69%) patients had antifungal therapy prior to CCT. Cultures revealed a variety of fungi with multiple patients harboring multiple fungi. Saccharomyces cerevisiae was most common, present in 7(28%) patients. Also noteworthy was 1 patient with positive CCT had negative cultures.

Significant associations were noted with esophagitis 12(48%) and Barrett’s esophagus 7(28%). Lastly, all patients suffered from complications including: multiple hospitalizations for alcohol intoxication 8(32%), end stage liver disease 4(16%), arrest for driving under the influence 6(24%), pancreatitis 2(8%), and traumatic subdural hemorrhage 1(4%).

Discussion: ABS represents a challenge in establishing diagnosis and administering effective treatment. These cases demonstrate ABS’s varied presentation, shows our testing and treatment methodology, and highlights areas for further research both in diagnostic modalities and treatment protocols to more effectively manage this orphan disease.



Disclosures:


James A. Ducey, MD¹, Fahad Malik, MD², Prasanna Wickremesinghe, MD¹. A0255 - A Case Series of 25 Auto-Brewery Syndrome Patients: A Single Community Hospital Experience, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.