Small Intestinal Bacterial Overgrowth (SIBO) occurs when bacteria enter your normally sterile small intestine and begin to colonize. SIBO is a disorder of excessive bacterial growth in the small intestine, unlike the colon (or large bowel), which is rich with bacteria.

Watch a quick introduction to the test here: https://www.youtube.com/watch?v=3UO3TamU9jI

Indications

Overview

Small Intestinal Bacterial Overgrowth (SIBO) occurs when bacteria appear in the normally more sterile small intestine and begin to colonize. Hydrogen (H₂) and methane (CH₄) gasses are produced in the digestive system primarily only by the bacterial fermentation of carbohydrates (sugars, starches or vegetable fibers). The generation of H2 and/or CH4 will result in the absorption of some of these gases into the blood stream from the site of their production, and they will appear in the expired air. If either of the gases appear in the expired air, it is usually a signal that carbohydrates or carbohydrate fragments have been exposed to bacteria, permitting such fermentation to take place and that SIBO can be suspected.

Studies have indicated that potentially up to 80% of patients with IBS may in fact have SIBO which this Hydrogen /Methane breath test can easily and non-invasively help determine.

Analytes:

• Methane (CH₄)
• Hydrogen (H₂)

Learn more about SIBO testing in clinical practice by watching our webinar: https://www.youtube.com/watch?v=7ep2UGnY2T8

Practical

Specimen

Breath

Container

• Vacuum-sealed collection tubes

Patient preparation

• Requires fasting 12 hours prior to collection
• This test will take 3 hours to complete
  
• Preparation for the test starts 2-4 weeks before collection ( Please check sample collection instructions)

Please note this test will take 3 hours to complete. 

Research

Research

• Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. 2010;16(24).

• Chedid V, Dhalla S, Clarke JO, et al. Herbal therapy is equivalent to Rifaximin for the treatment of small intestinal bacterial Overgrowth. Global Advances in Health and Medicine. 2014;3(3):16–24.

• Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial Overgrowth. 2007;3(2).

• Erdogan A, Rao SSC. Small Intestinal Fungal Overgrowth. Current Gastroenterology Reports. 2015;17(4).

• Fasano A. Leaky gut and autoimmune diseases. Clinical reviews in allergy & immunology. 2011;42(1):71–8.

• Gabbard S, Lacy B, Levine G, Crowell M. The impact of alcohol consumption and cholecystectomy on small intestinal bacterial overgrowth. Digestive diseases and sciences. 2013;59(3):638–44.

• Ghoshal UC, Srivastava D, Ghoshal U, Misra A. Breath tests in the diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome in comparison with quantitative upper gut aspirate culture. European Journal of Gastroenterology & Hepatology. 2014;26(7):753-760.

• Ghoshal UC. How to Interpret Hydrogen Breath Tests. Journal of Neurogastroenterology and Motility. 2011;17(3):312-317.

• Hauge T, Persson J, Danielsson D. Mucosal bacterial growth in the upper gastrointestinal tract in alcoholics (heavy drinkers). Digestion. 2009;58(6):591–595.

• Lauritano E, Gabrielli M, Scarpellini E, et al. Small intestinal bacterial overgrowth recurrence after antibiotic therapy. The American journal of gastroenterology. 2008;103(8):2031–5.

• Levitt MD. Volume and Composition of Human Intestinal Gas Determined by Means of an Intestinal Washout Technic. New England Journal of Medicine. 1971;284(25):1394-1398.

• Lloyd-Still JD, Shwachman H. Duodenal microflora. The American Journal of Digestive Diseases. 1975;20(8):708-715.

• Methodology and Indications of H2-Breath Testing in Gastrointestinal Diseases: the Rome Consensus Conference. Alimentary Pharmacology & Therapeutics. 2009;29:1-49.

• Newberry C, Tierney A, Pickett-Blakely O. Lactulose Hydrogen Breath Test Result Is Associated with Age and Gender. BioMed Research International. 2016;2016:1-5.

• Rana S, Sharma S, Kaur J, Sinha S, Singh K. Comparison of Lactulose and Glucose Breath Test for Diagnosis of Small Intestinal Bacterial Overgrowth in Patients with Irritable Bowel Syndrome. Digestion. 2012;85(3):243-247.

• Rana SV, Bhardwaj SB. Small intestinal bacterial overgrowth. Scandinavian Journal of Gastroenterology. 2008;43(9):1030-1037.

• Roland B, Ciarleglio M, Clarke J, et al. Small intestinal transit time is delayed in small intestinal bacterial Overgrowth. Journal of clinical gastroenterology. 2014;49(7):571–6.

• Saad RJ, Chey WD. Breath Testing for Small Intestinal Bacterial Overgrowth: Maximizing Test Accuracy. Clinical Gastroenterology and Hepatology. 2014;12(12):1964-1972.

• Shah ED, Basseri RJ, Chong K, Pimentel M. Abnormal Breath Testing in IBS: A Meta-Analysis. Digestive Diseases and Sciences. 2010;55(9):2441-2449.