Fecal Microbiota Transplants Explored for Auto-Brewery Syndrome

Auto-brewery syndrome is a rare medical condition in which certain gut microorganisms convert carbohydrates into ethanol, resulting in symptoms of intoxication without alcohol consumption. Interest in new treatment approaches has grown following reports of successful intervention using fecal microbiota transplantation.

Various microorganisms, including yeasts such as Saccharomyces cerevisiae and Candida albicans, as well as bacteria like Klebsiella pneumoniae, have been identified as contributors to auto-brewery syndrome. The condition has been managed with a range of treatments, but long-term solutions remain limited.

A published case report described a 47-year-old man in Belgium who received a fecal microbiota transplant (FMT) in June 2017 after other therapies did not resolve his symptoms. According to the report, the patient’s symptoms of ethanol intoxication ceased immediately after the procedure and he remained symptom-free for nearly three years while following a regular diet.

Interest in FMT as a treatment for auto-brewery syndrome has led to further research. A systematic review covering 20 patients with gut fermentation syndrome documented the use of antibiotics, antifungals, low-carbohydrate diets, and probiotics, and noted the potential role of fecal microbiota transplantation as an emerging option.

What the numbers show

• One case report documented 34 months of symptom-free status after FMT
• 20 patients were included in a systematic review of gut fermentation syndrome treatments
• A clinical trial (NCT06083142) is set to begin on January 24, 2025

The upcoming clinical trial (NCT06083142) is designed to evaluate the safety and feasibility of oral-capsule fecal microbiota transplantation for individuals diagnosed with auto-brewery syndrome. The study is currently recruiting participants and will use a structured protocol involving antibiotic pretreatment and colon cleansing before administering five oral doses of FMT capsules over one week.

Participants in the trial will be monitored for six months after treatment to assess safety outcomes. The study aims to provide more data on the effectiveness and tolerability of oral FMT capsules for this rare condition.

Current treatment options for auto-brewery syndrome have included dietary changes, antimicrobial medications, and probiotics, but sustained remission has been difficult to achieve in some cases. The inclusion of FMT in ongoing research reflects continued efforts to identify more reliable therapies for affected patients.

Research in this area continues as clinicians and investigators seek to better understand the underlying causes of auto-brewery syndrome and to evaluate new treatment strategies through structured clinical studies.

* This article is based on publicly available information at the time of writing.