Fahad Malik, MD, Prasanna Wickremesinghe, MD, Himanga Kalinga, MD, Jessie Saverimuttu, MD
Richmond University Medical Center, Staten Island, NY
Introduction: Gut fermentation syndrome (GFS) is a rare medical phenomenon in which ingestion of carbohydrate meals results in alcohol production through different biochemical pathways. These patients are presumed to have intestinal yeast fermenting carbohydrate to alcohol. This is due to fungi overgrowth in the digestive tract. This can often result in alcohol toxicity without any exogenous alcohol intake. The aim of this study was confirmation and treatment of GFS using a standardized carbohydrate challenge test followed by upper and lower endoscopy to obtain intestinal secretions to detect fungal growth.
Case Description/Methods: This presents five patients who presented with implications of alcoholism while denying use any exogenous alcoholic beverages. A long detailed history and physical examination was conducted in order to screen these patients whose symptoms were unlikely due to exogenous drinking. All other possible primary causes were ruled out. There are currently no established diagnostic criteria to confirm GFS or treat this condition. We therefore propose the following protocol for this. It was important to make certain that patients with suspected GFS who have elevated blood or breath alcohol levels were not surreptitiously drinking.
In our provocative carbohydrate challenge test, we gave the patients 200g of glucose by mouth after an overnight fast with blood drawn at timed intervals of 0, ½, 1, 2, 4, 8, 16, and 24 hours for glucose and blood alcohol levels. This test was aborted early if alcohol levels become elevated in the first few hours. This used algorithm, carbohydrate challenge results and a comparison of all five patients is shown in the table format.
If any elevated serum alcohol was detected without any drinking then these patients were recommended to participate for further testing. Routine laboratory testing and stool microbiome were sent for specification. Upper and lower endoscopy were performed during which secretions were collected for bacterial and fungal cultures along with biopsies to further study.
Discussion: Any patient denying alcohol ingestion but who has elevated alcohol levels should be investigated. The earliest symptoms of GFS may be mood changes. Some of the patients were bought to us by a concerned family member. This condition was treated with dietary modifications, antifungal therapy, and probiotic use in our patients. We are only starting to recognize the complexity of this condition and are currently studying more patients using the proposed protocol.
Citation: Fahad Malik, MD, Prasanna Wickremesinghe, MD, Himanga Kalinga, MD, Jessie Saverimuttu, MD. P0207 - CASE SERIES OF 5 PATIENTS DETECTED WITH GUT FERMENTATION SYNDROME. Program No. P0207. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.