Hydrogen Breath Test for Detecting Small Intestinal Bacterial Overgrowth (SIBO)
The best way to determine the presence of SIBO is to perform a hydrogen breath test. This simple procedure requires administering a challenge substrate (either lactulose or glucose), collecting patients’ breath samples with an easy to use straw and tube method, and sending the samples to our lab for measurement of hydrogen and methane levels. Test kits can be used in your office or sent home with your patient. A prepaid mailer to return the breath samples to the lab comes with each kit. Upon arrival, tests are analyzed and a report faxed or emailed to you on the same day.
There are dietary modifications the day before testing, avoidance of certain medications and an overnight fast required prior to taking the test. Please read the SIBO lactulose preparation instructions
The test kit is designed for use by patients or staff with no previous experience. Watch details of the test procedure here. The process begins by taking a baseline breath sample by blowing through a straw into a breath collection tube. The next step is to dissolve the lactulose or glucose challenge dose in water and drink it. The last step is to take three (3) additional breath samples over a period of 90 minutes. Please read the complete SIBO lactulose test instructions.
The incidence of bacterial overgrowth increases with age. Atrophic gastritis (chronic inflammation of the stomach), estimated to occur in 20 to 30% of healthy seniors, is the most common cause of reduced gastric acid secretion. This is a predisposing factor for bacterial overgrowth. SIBO occurs commonly in patients with diabetes mellitus, particularly those with gastroparesis. Futhermore, recent research by Dr. Mark Pimentel has suggested a link between irritable bowel syndrome and SIBO. In one study, 78% of the 157 patients diagnosed with IBS also tested positive for SIBO using the hydrogen breath test.
Patients are at potential risk of small intestinal bacterial overgrowth with the following clinical conditions:
- Irritable Bowel Syndrome
- Immunodeficiency syndromes
- Chronic pancreatitis
- Inflammatory Bowel Disease
- Celiac Disease
- Long-term treatment with anti-secretory (e.g. PPI’s) medications
- Adominal cramps
- Abdominal bloating
- Gas (flatulence)
- Steatorrhea (fat in stool)
- Weight loss
- Features associated with micronutrient deficiencies (Vitamins B12, A, D, and E, iron, thiamine, nicotinamide)
SIBO hydrogen breath testing uses the orally ingested carbohydrate such as lactulose or glucose as substrates. The patient, once properly prepared for the test, takes a baseline breath sample and ingests 10 grams of lactulose or 75 grams glucose dissolved in water. Next, the patient collects additional breath samples at 30, 60 and 90 minutes, post ingestion.
Metabolic Solutions measures both hydrogen and methane levels in all breath samples. These gases are only produced in the body from intestinal bacteria. Bacteria ferment sugars such as lactulose or glucose to hydrogen and/or methane gas. Hydrogen and methane are absorbed by the intestinal mucosa and get transported to the lungs. A change in the level of hydrogen gas above 20 parts per million within 90 minutes and/or a change in the level of methane gas above 10 parts per million is diagnostic for SIBO.
- View an example report.
The goal when treating SIBO should not be to sterilize the gastrointestinal tract but to reduce the number of pathogenic bacteria present. Antibiotic therapy against both aerobic and anaerobic organisms has been proposed to treat SIBO. Recently, rifaximin was shown to be more effective than tetracycline when treating patients with abnormal bacterial overgrowth breath tests. Current interest in the treatment of SIBO has also focused on the use of prebiotics and probiotics.
For more lactulose SIBO resources, visit our Learning Center.
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