Pondicherry Journal of Nursing
Volume 13 | Issue 3 | Year 2020

Auto-brewery Syndrome

Nanthini D Kalaiarasan

Department of Nursing, Kasturba Gandhi Nursing College, Puducherry, India

Corresponding Author: Nanthini D Kalaiarasan, Department of Nursing, Kasturba Gandhi Nursing College, Puducherry, India, Phone: +91 8056861301, e-mail:

How to cite this article Kalaiaasan ND. Auto-brewery Syndrome. Pon J Nurs 2020;13(3):70–72.

Source of support: Nil

Conflict of interest: None


Auto-brewery syndrome is a rare medical condition where ethanol is produced by endogenous fermentation in the digestive tract.1 In this rare medical condition, the intoxication of ethanol is produced by the yeast type Saccharomyces cerevisiae, which is known for its use in the production of bread and alcoholic beverages.2 It occurs in patients with small bowel syndrome after surgical resection due to the fermentation of malabsorbed carbohydrates.3,4

Keywords: Brewery, Digestive system, Ethanol.


Auto-brewery syndrome is called gut fermentation syndrome and endogenous ethanol fermentation.4 This is sometimes called “intoxication.” This rare condition can make you intoxicated without alcohol. This is when your body converts sugars and carbs (carbohydrates) into alcohol. Saccharomyces cerevisiae, a type of yeast, has been identified as pathogenic to this condition. Recent research has shown that Klebsiella pneumoniae bacteria can dissolve carbohydrates in alcohol, which can accelerate nonalcoholic fatty liver diseases (Fig. 1).4


Auto-brewery syndrome is a rare condition first reported by the medical community in the 1950s.4,5 Since their initial discovery, researchers have identified auto-brewery syndrome in adults and children.5 However, the authors of the 2019 case report at BMJ Open Gastroenterology believe that autoimmune syndrome may be the underlying medical condition.6 Children with toddlers and small bowel syndrome are more likely to have auto-brewery syndrome. A medical case reports that a 3-year-old child with small bowel syndrome has “brewery syndrome” after drinking fruit juice, which is naturally high in carbohydrates7,8


Auto-brewery syndrome is likely to develop to maintain medical condition. In addition to:

Fig. 1: Digestive tract




There are many different treatment options for auto-brewery syndrome, including:


Antifungal medications for the treatment of auto-brewery syndrome are:



Auto-brewery syndrome is a condition that occurs when the intestinal yeast produces large amounts of ethanol, which is similar to anesthetic properties.15,16 People with auto-brewery syndrome report abnormally high blood alcohol levels even when they do not drink alcohol. It is diagnosed by multiple investigations, including endoscopy and stool testing, and corrected through antifungal medications and dietary management.17


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2. 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(12):1448–1450. DOI: 10.1093/ecco-jcc/jjw098.

3. Cordell BJ, Kanodia A, Miller GK. Case-control research study of auto-brewery syndrome. Glob Adv Health Med 2019;8:2164956119837566. DOI: 10.1177/2164956119837566.

4. 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(1):e000325. DOI: 10.1136/bmjgast-2019-000325.

5. 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(7):799–802. DOI: 10.1097/01.meg.0000223906.55245.61.

6. Green AD, Antonson DL, Simonsen KA. Twelve-year-old female with short bowel syndrome presents with dizziness and confusion. Pediatr Infect Dis J 2012;31(4):425. DOI: 10.1097/INF.0b013e318241590f.

7. Jansson-Nettelbladt E, Meurling S, Petrini B, Sjölin J. Endogenous ethanol fermentation in a child with short bowel syndrome. Acta Paediatr 2006;95(4):502–504. DOI: 10.1080/08035250500501625.

8. Dahshan A, Donovan K. Auto-brewery syndrome in a child with short gut syndrome: case report and review of the literature. J Pediatr Gastroenterol Nutr 2001;33(2):214–215. DOI: 10.1097/00005176-200108000-00024.

9. 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(1-3):97–100. DOI: 10.1016/j.forsciint.2011.09.003.

10. Bivin WS, Heinen BN. Production of ethanol from infant food formulas by common yeasts. J Appl Bacteriol 1985;58(4):355–357. DOI: 10.1111/j.1365-2672.1985.tb01473.x.

11. Aragonès G, González-García S, Aguilar C, Richart C, Auguet T. Gut microbiota-derived mediators as potential markers in nonalcoholic fatty liver disease. Biomed Res Int 2019;2019:8507583. DOI: 10.1155/2019/8507583.

12. Nair S, Cope K, Risby TH, Diehl AM, Terence RH. Obesity and female gender increase breath ethanol concentration: potential implications for the pathogenesis of nonalcoholic steatohepatitis. Am J Gastroenterol 2001;96(4):1200–1204. DOI: 10.1111/j.1572-0241.2001.03702.x.

13. Baker SS, Baker RD, Liu W, Nowak NJ, Zhu L. Role of alcohol metabolism in non-alcoholic steatohepatitis. PLoS ONE 2010;5(3):e9570. DOI: 10.1371/journal.pone.0009570.

14. Zhu L, Baker RD, Zhu R, Baker SS. Gut microbiota produce alcohol and contribute to NAFLD. Gut 2016;65(7):1232. DOI: 10.1136/gutjnl-2016-311571.

15. Iizumi T, Battaglia T, Ruiz V, Perez Perez GI. Gut microbiome and antibiotics. Arch Med Res 2017;48(8):727–734. DOI: 10.1016/j.arcmed.2017.11.004.

16. Maier L, Pruteanu M, Kuhn M, Zeller G, Telzerow A, Anderson EE, et al. Extensive impact of non-antibiotic drugs on human gut bacteria. Nature 2018;555(7698):623–628. DOI: 10.1038/nature25979.

17. Ushida Y, Talalay P. Sulforaphane accelerates acetaldehyde metabolism by inducing aldehyde dehydrogenases: relevance to ethanol intolerance. Alcohol Alcohol 2013;48(5):526–534. DOI: 10.1093/alcalc/agt063.

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