# Autobrewery Syndrome and Endogenous Ethanol Production in Patients with MASLD: A Perspective from Chronic Liver Disease

## TL;DR

This paper reviews autobrewery syndrome, a rare condition where gut microbes produce ethanol, and its potential role in liver disease.

## Contribution

The paper provides a comprehensive overview of the clinical features, microbial causes, and potential impact on liver disease of autobrewery syndrome.

## Key findings

- Autobrewery syndrome involves gut microbiota fermenting carbohydrates into ethanol.
- The condition can mimic alcohol intoxication and may contribute to liver disease progression.
- Current management lacks standardized protocols, but potential therapeutic strategies are discussed.

## Abstract

Autobrewery syndrome is a rare condition characterized by the endogenous fermentation of carbohydrates by gut microbiota, which exceeds the liver’s detoxification capacity and leads to signs and symptoms of acute alcohol intoxication. This condition has significant clinical, social, and legal implications. Beyond the acute effects, the role of excessive endogenous ethanol production in the progression of chronic diseases—particularly liver disease—is still under investigation. In this review, we aim to describe the key clinical features of autobrewery syndrome, identify the main microbial pathogens involved, and explore the potential impact of endogenous ethanol production on the development and progression of chronic liver disease. Although robust data and standardized treatment protocols are currently lacking, we discuss the general principles of management and outline possible therapeutic strategies and future perspectives.