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Largest Study Links Gut Bacteria to Auto‑Brewery Syndrome as Fecal Transplant Trial Begins

Researchers found patients’ stool produced far more ethanol in lab tests, pointing to a simpler diagnostic and treatment targets in fermentation pathways.

Overview

  • The Nature Microbiology study analyzed 22 people with the condition, 21 household partners, and 22 healthy controls, led by teams at UC San Diego and Mass General Brigham.
  • Evidence implicated Escherichia coli and Klebsiella pneumoniae and showed elevated enzymes in ethanol‑producing pathways during symptom flares.
  • Stool from patients generated significantly more ethanol than samples from partners or controls, supporting development of a stool‑based diagnostic alternative to supervised blood testing.
  • Investigators propose focusing on microbial fermentation enzymes, and lab work showed antibiotic treatment could reduce ethanol production in cultured samples.
  • One patient achieved over 16 months of remission after repeat fecal microbiota transplantation, and a phase 1 trial is now evaluating this approach in eight patients.