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Auto-brewery syndrome is a rare medical condition in which intoxicating quantities of ethanol are produced through endogenous fermentation within the digestive system. Saccharomyces cerevisiae, a type of yeast best known for its uses in producing bread and alcoholic beverages, has been identified as a pathogen for this condition. Recent research has also shown that Klebsiella bacteria can similarly ferment carbohydrates to alcohol in the gut, which can accelerate non-alcoholic fatty liver disease.

It can occur in patients of short bowel syndrome after surgical resection because of fermentation of malabsorbed carbohydrates.

Claims of endogenous fermentation of this type have been used as a defense against drunk driving charges. But since some judges reject this defense and have issued prison terms, doctors caution that "these patients have to be very careful about driving a motor vehicle" since in those jurisdictions, these patients would be arrested for being over the legally defined blood alcohol content limit (which varies vastly by state and local jurisdiction) even if the patients were not actually impaired at the time of arrest.

One case went undetected for 20 years.

It has also been investigated, but eliminated, as a possible cause of sudden infant death syndrome.

A variant occurs in persons with liver abnormalities that prevent them from excreting or breaking down alcohol normally. Patients with this condition can develop symptoms of auto-brewery syndrome even when the gut yeast produces a quantity of alcohol that is too small to intoxicate a healthy individual.

Another variant, urinary auto-brewery syndrome, is when the fermentation occurs in the urinary bladder rather than the gut. This single reported case is associated with diabetes due to the presence of sugar in the urine for the yeast to ferment. The person did not develop symptoms of intoxication, but did test positive in the urine for alcohol. Fermentation may continue after the urine is expressed, resulting in it developing an odor resembling wine.

Symptoms
This disease can have profound effects on everyday life. As well as the recurring side effects of excessive belching, dizziness, dry mouth, hangovers, disorientation, irritable bowel syndrome, and chronic fatigue syndrome, it can lead to other health problems such as depression, anxiety and poor productivity in employment. The random state of intoxication can lead to personal difficulties, and the relative obscurity of the condition can also make it hard to seek treatment.

A case of urinary fermentation of carbohydrates by endogenous microorganisms leading to urinary ethanol has been reported.

Diagnosis
Alcohol can be detected by testing blood or the breath. This may have to be repeated at multiple times of the day to account for naturally occurring fluctuations.

Treatment
There are different treatments that can be used by themselves or in combination. Dietary carbohydrate control, antifungal or antibiotic therapy, general antibiotic avoidance, and probiotics have all shown positive effects as treatments.