TUESDAY, Aug. 18, 2020 — In a first, doctors have used a fecal transplant to treat a rare condition that causes the body to brew its own alcohol.
The disorder, known as auto-brewery syndrome (ABS), occurs when yeast builds up in the gut and converts sugar from food into alcohol. The result is a lot like being drunk: Blood alcohol spikes, causing symptoms such as dizziness, disorientation, coordination problems and mood changes.
And as anyone with ABS knows, it’s a miserable and perplexing condition, according to Barbara Cordell, an adjunct professor at Panola College, in Texas.
Cordell is also president of the nonprofit Auto-Brewery Syndrome Information and Research. Her interest in the condition began through personal experience, when her husband developed symptoms — though it took years to trace them to ABS.
That is a typical scenario, Cordell said. Few doctors actually recognize and treat the condition, she noted.
That’s why the new case, reported Aug. 18 in the Annals of Internal Medicine, is “exciting,” Cordell said. It’s the first known instance of doctors treating ABS with a fecal transplant — a procedure largely considered investigational.
Cordell said it could be a “breakthrough” for people with severe cases of ABS that do not respond to simpler fixes, like diet changes.
Fecal transplants involve transferring stool from a healthy donor into the patient’s gastrointestinal tract. The idea is to change the bacterial composition of the gut, hopefully to a healthier balance.
The procedure is sometimes used to treat severe gastrointestinal infections caused by Clostridium difficile bacteria.
It is also being tested as a treatment for certain chronic gut conditions, including ulcerative colitis and irritable bowel syndrome (IBS). Dr. Danny De Looze, of University Hospital Ghent, in Belgium, recently completed a study of patients with stubborn cases of IBS — and found the transplant can ease their symptoms.
So when De Looze encountered a patient with severe auto-brewery syndrome, a light bulb went off.
“Knowing the success of (fecal transplant) in C. diff, I thought it would be a good idea to treat him the same way,” De Looze said.
The patient, a 47-year-old man, had already tried the known conservative treatments for ABS: a low-carbohydrate diet and anti-fungal medication. Yet his blood alcohol levels remained high and his symptoms persisted.
That all changed after the transplant, using a donation from the man’s adult daughter. Nearly three years later, he has remained symptom-free, according to De Looze. He also regained his driver’s license, which was taken away after a random police check found soaring blood-alcohol levels.
Whether fecal transplants will become an option for more ABS patients is difficult to predict.
ABS, itself, remains mysterious. But among the cases reported so far, there does seem to be a common denominator, Cordell said: Prolonged antibiotic use. It’s thought that in certain vulnerable people, that disrupts the gut’s normal bacterial makeup in a way that allows alcohol-producing yeast to thrive.
De Looze’s patient started noticing symptoms one month after taking back-to-back courses of antibiotics. He’d also had gastric bypass surgery 14 years prior.
According to Cordell, gastric bypass is thought to be one of the factors that makes people susceptible to auto-brewery syndrome. The same is true of certain conditions that disrupt the gut’s microbial balance — including Crohn’s disease, short bowel syndrome and obesity.
“But some people with auto-brewery have no underlying conditions,” Cordell said. “We don’t know why they get it.”
Often, ABS does respond to a low-carb diet and anti-fungal medication. But for particularly tough cases, Cordell said, a fecal transplant makes sense.
“We’re not talking about doing this for everyone,” she stressed. “But this is an option we’ve been thinking about for the sickest patients.”
De Looze said he would “certainly encourage” doctors to try the approach.
Ideally, he noted, a clinical trial would be done to formally test the treatment. “But since this is a very rare disease,” De Looze said, “it will be practically impossible.”
He added that his patient suffered no side effects. However, fecal transplants are not risk-free: The U.S. Food and Drug Administration recently warned that they can transmit serious infections. That was based on reports of six patients who developed new bacterial infections after having fecal transplants to treat C. diff infections.
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Posted: August 2020