SIBO Test (Breath Test)

Hydrogen Breath Test for Small Intestinal Bacterial Overgrowth (SIBO)

The hydrogen breath test for small intestinal bacterial overgrowth is a non-invasive, low risk, accurate and fast tool to identify this serious condition. Metabolic Solutions makes it easy for healthcare professionals to test for small intestinal bacterial overgrowth by providing breath test kits and lab services to analysis the breath samples. We offer a low cash price, and if you qualify we can directly bill patient’s health insurance. No long term commitments, no minimum orders and no risky out of pocket costs. This test is an important tool in maintaining patient wellness while offering the potential for new profit center opportunity.

Why is it important to test for SIBO?

The aging of the population has increased the incidence of bacterial overgrowth. Atrophic gastritis, estimated to occur in 20 to 30% of the healthy elderly population, is the most common cause of reduced gastric acid secretion. This is a predisposing factor for bacterial overgrowth. The obesity epidemic has led to an outbreak of new diabetes mellitus cases. SIBO occurs commonly in patients with diabetes mellitus, particularly those with gastroparesis.

A recent publication by M. Pimentel, E.J. Chow and H.C. Lin has suggested a link between IBS and bacterial overgrowth. In this study, over 78% of the 157 patients with IBS tested positive with the hydrogen breath test. This is an important development for people that suffer from IBS because bacterial overgrowth can be successfully treated. Linking bacterial overgrowth with IBS makes sense because it relates to the frequent IBS complaint of bloating after eating. As the bacteria ferment food, gas is released into the small intestine, causing painful bloating and other symptoms. In addition, patients are at potential risk of small intestinal bacterial overgrowth with the following clinical conditions:

  • Rosacea
  • Fibromyalgia
  • Cirrhosis
  • Immunodeficiency syndromes
  • Chronic pancreatitis
  • End stage renal disease
  • Inflammatory Bowel Disease
  • Short bowel syndrome
  • Celiac Disease
  • Radiation enteritis
  • Long-term treatment with anti-secretory (e.g., PPIs) medications
  • What are the symptoms of SIBO Infection?

Symptoms of SIBO include

  • Abdominal cramps
  • Abdominal bloating
  • Diarrhea
  • Gas (flatulence)
  • Steatorrhea
  • Weight loss
  • Features associated with micronutrient deficiencies (Vitamins B12, A, D, and E, iron, thiamine, nicotinamide)

What is the principle of the hydrogen breath test?

SIBO hydrogen breath testing uses the orally ingested carbohydrate lactulose as a substrate. The patient, once properly prepared for the test, takes a baseline breath sample and ingests 10g of lactulose dissolved in water. Next, the patient collects additional breath samples at 20, 40 and 60 minutes, post ingestion.

Hydrogen and methane gas are only produced in the body from intestinal bacteria. Bacteria ferment sugars such as lactulose to hydrogen and/or methane gas. Hydrogen and methane are absorbed by the intestinal mucosa, enter the vasculature, and get transported to the lungs. A change in the level of hydrogen and/or methane gas above 20 parts per million within 60 minutes is diagnostic for SIBO. The majority, but not all of the population produce hydrogen gas. However, approximately 15% of patients are methane producers rather than hydrogen producers. These patients will only be properly diagnosed by measuring methane levels. As a result, each breath specimen is measured by Metabolic Solutions for both hydrogen and methane levels.

How do you treat SIBO?

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.

Peppermint oil has also been used, in combination with caraway oil, to treat the symptoms of functional dyspepsia (FD). The symptoms of FD are similar to SIBO and include abdominal pain ,nausea, bloating, gas, and indigestion. Clinical trials using enteric-coated peppermint and caraway oil vs. placebo have documented remarkable results in the treatment of FD, with reductions in pain, heaviness, pressure, and fullness. In all studies, the dose administered was 90 mg peppermint oil and 50 mg caraway oil twice daily; the combination was reported as safe and well tolerated.



Glucose Hydrogen (Bacterial Overgrowth) Breath Test


[Test is 2 hours long and there is space in testing room for the patient only.]


Please follow the below instructions for the best possible results from this test.  If you need further assistance, please call (540)667-1244.  If you have diabetes, you should be aware that the glucose given during the test may cause a spike in your blood sugar, which should dissipate rapidly during the test period.


We don’t feel that you need to change your diabetes regimen just for this test (but simply be aware of the blood sugar spike).  However, if you have further concerns, feel free to contact the physician that manages your diabetes.  Inform him/her that you will be given 100gm of glucose (similar to the “old” glucose tolerance test) so that he/she can provide you with further advice.




2 weeks prior to the test:


·       Antibiotics must be completed 2 weeks prior to this test


·       No colonoscopies or barium studies 2 weeks prior to the test


Day prior to testing:


·       Patient needs to be NPO (Nothing by Mouth) for 12 hours prior to test. (beginning at 8pm the night before the test)


·       Patients need to avoid foods listed AND follow diet for 12 hours prior to the NPO request. (8a-8pm day prior)


·       No smoking, including second hand smoke for 1 hour prior, or at any time during the test.


·       No sleeping or vigorous exercise for at least 1 hour prior, or at any time during the test.


·       No antibiotics for at least 14 days prior to the test.


·       No probiotics the day before the test.


·       No fiber 2 days prior to the test.


·       You may take your usual daily medications with water the morning of the test. If you are diabetic please be prepared to eat at 11am.


During the test:


·       You may only drink water during the test.


·       No gum, hard candy or mints during the test.


If any of the above apply-you will be required to reschedule your test.



FOODS YOU CAN EAT THE DAY PRIOR TO TEST (eat from 8a-8p the day prior)



·       Baked or broiled chicken or turkey (salt and pepper only)


·       Baked or broiled fish. (Salt and pepper only)


Plain, steamed white rice. (You may cook the rice in broth for added flavor)


·       Eggs


·       Clear chicken or beef broth.


·       Black coffee (no cream or sugar)


·       Unsweet tea


·       Water






·       Grain Products: pastas, whole grains (including cereal and toast), brans, high-fiber cereals.


·       Fruits: fruit juices, applesauce, fresh fruits, canned fruit, raw or dried fruits(raisins, berries)


·       Vegetables: vegetable juices, potatoes, alfalfa sprouts, beets, green/yellow beans, celery, bell peppers, broccoli, Brussel sprouts, cabbage, kale, corn, any canned or fresh vegetables.


·       Nuts, Seeds, Beans: All nuts, seeds, beans as well as foods that may contain seeds.


·       All Dairy products except eggs: Milk, cheese, yogurt, ice cream, butter.


·       Meats, Pastas, corn or products that contain corn (except those listed in OK food list)


What is a glucose hydrogen breath test?


The Glucose Hydrogen breath test is used to identify abnormal growth of bacteria in the intestine.  You will be asked to breathe into a breath collection device and your breath will be collected and analyzed for the presence of hydrogen.


Normally, small amounts of bacteria are found in the intestine.  If there is a significant increase in the amount of bacteria, food and nutrients are not absorbed properly.  Bacterial overgrowth can result from a slow transit of food through the bowels or from certain medications.  Symptoms may include abdominal pain, bloating, gas and diarrhea.


What should I expect during the test?


Breath test samples must be read by the physician within a timely manner.  Your doctor will send you the results by mail or gPortal.  If the test indicates you do have small bowel bacterial overgrowth, it may be treated with antibiotics.


What should I expect after the test?


You may resume your typical diet immediately after the test without any limitations.  The test measurements will be forwarded to your GI Physician for review and interpretation within a timely manner (typically less than 48 hours).  Your doctor will send you the results by mail or gPortal.  If the test indicates you do have small bowel bacterial overgrowth, you may be treated with antibiotics.