Endogenous ethanol production in a patient with chronic intestinal pseudo-obstruction and small intestinal bacterial overgrowth

Article · August 2006with286 Reads
DOI: 10.1097/01.meg.0000223906.55245.61 · Source: PubMed
Abstract
The case of the gastrointestinal production of ethanol from Candida albicans and Saccharomyces cerevisiae in a Caucasian man with chronic intestinal pseudo-obstruction is reported. The patient, who declared to have always abstained from alcohol, was hospitalized for abdominal pain, belching and mental confusion. The laboratory findings showed the presence of ethanol in the blood. Gastric juice and faecal microbiological cultures were positive for C. albicans and S. cerevisiae. At home, he was on oral antibiotic therapy with amoxicillin plus clavulanic acid for a small bowel bacterial overgrowth, associated with a simple sugar-rich diet. Twenty-four hours after stopping both the antibiotic therapy and the simple sugar-rich diet, the blood ethanol disappeared. A provocative test, performed by giving amoxicillin plus clavulanic acid associated with the simple sugar-rich diet was followed by the reappearance of ethanol in the blood. A review of the literature is reported.
    • A remarkable exception to this metabolic pattern is frequently observed in the auto-brewery syndrome. This disorder, in addition to SIBO, is accompanied by fungal overgrowth of alcohol-producing organisms such as Candida sp and/or Saccharomyces cerevisiae [62,71,72,76,[100][101][102]. Characteristically, auto-brewery syndrome patients produce massive quantities of EE from dietary carbohydrates.
    File · Data · Jun 2016 · World Journal of Gastroenterology
    • Gut bacteria metabolize ethanol to acetaldehyde by cytochrome P450 2E1 (CYP2E1) that produces a large number of reactive oxygen species (ROS), which could damage intestinal barrier components including mucus layer and tight junctions. A recent study also demonstrated that bacterial metabolism produces endogenous ethanol, which might also have deleterious effects on the gut barrier [65]. Probiotics, therefore, could contribute to intestinal barrier function by modulating certain gut bacteria leading to reduced metabolism of alcohol and ROS production in the intestine.
    [Show abstract] [Hide abstract] ABSTRACT: Despite extensive research, alcohol remains one of the most common causes of liver disease in the United States. Alcoholic liver disease (ALD) encompasses a broad spectrum of disorders, including steatosis, steatohepatitis, and cirrhosis. Although many agents and approaches have been tested in patients with ALD and in animals with experimental ALD in the past, there is still no FDA (Food and Drug Administration) approved therapy for any stage of ALD. With the increasing recognition of the importance of gut microbiota in the onset and development of a variety of diseases, the potential use of probiotics in ALD is receiving increasing investigative and clinical attention. In this review, we summarize recent studies on probiotic intervention in the prevention and treatment of ALD in experimental animal models and patients. Potential mechanisms underlying the probiotic function are also discussed.
    Full-text · Article · Feb 2016
    • As a result, metabolites with unclear origins can be classified in an intermediate group. For example, endogenous ethanol is not a metabolite of human metabolism, but a byproduct of gut microbes [97, 98], which is associated with nonalcoholic fatty liver disease [99]. In all, biotransformation (metabolism) and transportation are essential to the metabolic network of host and microbial interactions to dispose of endogenous and exogenous metabolites.
    [Show abstract] [Hide abstract] ABSTRACT: Determination of pharmacokinetics (PKs) of multicomponent pharmaceuticals and/or nutraceuticals (polypharmacokinetics, poly-PKs) is difficult due to the vast number of compounds present in natural products, their various concentrations across a wide range, complexity of their interactions, as well as their complex degradation dynamics in vivo. Metabolomics coupled with multivariate statistical tools that focus on the comprehensive analysis of small molecules in biofluids is a viable approach to address the challenges of poly-PK. This paper discusses recent advances in the characterization of poly-PK and the metabolism of multicomponent xenobiotic agents, such as compound drugs, dietary supplements, and herbal medicines, using metabolomics strategy. We propose a research framework that integrates the dynamic concentration profile of bioavailable xenobiotic molecules that result from in vivo absorption and hepatic and gut bacterial metabolism, as well as the human metabolic response profile. This framework will address the bottleneck problem in the pharmacological evaluation of multicomponent pharmaceuticals and nutraceuticals, leading to the direct elucidation of the pharmacological and molecular mechanisms of these compounds.
    Full-text · Article · Mar 2013
    • The exceptions are ethnic groups from the Far East (Japanese) [12], where in individuals with genetic metabolic deficit, the amount of ethanol in the blood can reach significant values after ingestion of rice. A similar phenomenon is seen in patients with chronic pseudo-obstruction [13], even in young children with short bowel syndrome [14,15]. Early investigations, which used semi-quantitative methods, showed that the values of EnEth levels in the blood are not significant.
    [Show abstract] [Hide abstract] ABSTRACT: Ethanol which is not ingested but is produced within the body through metabolic processes is known as "endogenous ethanol" (EnEth). The aim of this study was to determine whether there is a significant increase in the blood value of EnEth (BAC) in patients with diabetes mellitus and whether BAC correlates with increased glucose blood levels. In our study the BAC in the group of patients with diabetes mellitus (n=130) was significantly higher (mean value 2.65mg/L) than in the control group (mean value 0.40mg/L) when blood samples were analyzed by headspace gas chromatography method (HS-GC). The BAC levels obtained by semi-quantitative Widmark's method (n=60) were higher, and mean value in the patient group was 27.28mg/L. There was no correlation between the glucose blood levels and BAC, i.e. the auto-production of ethanol does not depend on blood glucose values. The mean value of ethanol in urine in patients with diabetes mellitus was 6.13mg/L measured by HS-GC method and 54.27mg/L when measured using Widmark's method. Even though the BAC in patients with diabetes mellitus was statistically significantly higher (p<0.01) in comparison to the control group, these amounts of EnEth do not increase greatly enough to affect legal proceedings, especially considering the fact that EnEth is measured in mg/mL. Our experimental results as well as data reported in the literature suggest that the cut-off level for the EnEth in blood should be set at BAC<0.1mg/mL for the semi-quantitative method, i.e. the values that appear at the second decimal place cannot be with certainty claimed to arise form the exogenous ethanol. For the HS-GS method cut-off level should be set at BAC<0.01mg/mL for the analytical parameters that were used in our experiments.
    Article · Sep 2011
    • SIBO deteriorates symptoms of acute colonic diverticulitis, protracts the course of the disease and thus could be an independent risk factor for future relapses of acute diverticulitis of the large bowel. Rifaximin was effective in the treatment of both acute colonic diverticulitis and SIBO in these patients[38].
    [Show abstract] [Hide abstract] ABSTRACT: Human intestinal microbiota create a complex polymicrobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO). SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacteriostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insufficiency, immunodeficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Non-invasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be complex, addressing all causes, symptoms and complications, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO.
    Full-text · Article · Jun 2010
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