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Largest Study Ties Gut Bacteria to Auto‑Brewery Syndrome, Signaling New Tests and Treatment Paths

A Nature Microbiology cohort identifies ethanol‑producing pathways in E. coli and Klebsiella during flares.

Overview

  • In stool assays, samples from patients during flares produced significantly more ethanol than those from household partners and healthy controls, supporting the feasibility of a stool‑based diagnostic.
  • The observational cohort compared 22 ABS patients with 21 household partners and 22 healthy controls, representing the largest systematic study of the condition to date.
  • Researchers linked ABS flares to elevated activity of fermentation enzymes and genes, pointing to therapies that target microbial metabolic functions rather than single species.
  • One patient achieved prolonged remission after fecal microbiota transplantation, and a phase 1 trial is now enrolling eight ABS patients to evaluate this approach.
  • The study implicates bacteria such as Escherichia coli and Klebsiella pneumoniae as ethanol producers in some patients, while noting that identifying causative microbes can vary case by case.