Overview

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.

Other tests that are often considered alongside the SIBO test are:

The Comprehensive stool analysis and parasites (CSAPx2). This is a measure of large intestinal function. Looking at bacterial and fungal overgrowth, as well as any parasitic infections. Furthermore it tests for how foods are being digested and absorped, and inflammation markers that maybe causing pain and discomfort.

Organic acids (organix) help provide detailed information about how the small intestine, and specifically the citric acid circle works. It helps provide information that illustrates how co factors such as vitamins, amino acids and minerals are deficient which in turn impact how the body digests and absorps. The test  also helps show any bacterial or fungal overgrowths that may be occuring in the small intestine.

Nordic Food panel, offers an insight into how the body may be producing sensitivities to commonly eaten foods, which in turn may be poorly digested, leading to a failure to properly absorp. A whole array of symptoms may be associated with these immune reactions to foods. Such as headaches, stomach pain, asthma and eczema, concentration problems etc.

Intestinal permeability and absorption. Shows whether the small intestine effectively has "leaks". Sometime this permeability is known as "leaky gut". Increased intestinal permeability syndrome is a condition caused by damage to the mucosal lining of the intestines. The intestines are designed to absorb nutrients as small molecules (molecular radius <40nm). When the bowel lining is altered or damaged, larger, undigested molecules are absorbed into the bloodstream and cause further inflammation, consequently inhibiting the absorption of beneficial nutrients. Increased intestinal permeability is primarily caused by overconsumption of alcohol, carbonated drinks, pharmaceutical drugs, and diets consisting of low-fiber, high-fructose, preserved, and processed foods. The effects can be varied and severe, ranging from fatigue and bloating to heightened food allergies, protein damage, detoxification inhibition, and a weakened immune system.

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.