SIBO Lactulose Breath Test
Small Intestinal Bacterial Overgrowth (SIBO) is recognized as being one of the underlying causes of Irritable Bowel Syndrome (IBS). People living with SIBO commonly experience:
- abdominal pain or discomfort
- bloating after meals
- excessive burping
- and heartburn
SIBO is also associated with:
- skin issues like rosacea, eczema, acne
- Non-Alcoholic Fatty Liver Disease (NAFLD)
- and Interstitial Cystitis
Bacteria produce a gas byproduct as a result of fermentation, like hydrogen, methane and/or hydrogen sulphide. Usually when there is microbial imbalance in the gut and if there is an overgrowth of bacteria, it can contribute to the common symptoms experienced by most people suffering from IBS. Bacteria tend to use fiber and fermentable sugars as their fuel source, which results in many people feeling worse when they eat a high fiber diet. Hydrogen predominant SIBO is highly correlated with loose stools or diarrhea due to the increased motility in the gut. Meanwhile, methane predominant SIBO is likely due to an overgrowth of Methanobrevibacter smithii, Archeae, which is highly correlated with constipation, the main symptom. Hydrogen sulphide is the less common form of SIBO and is linked with Salmonella, Proteus, Klebsiella, and Citrobacter infection and overgrowth. However, there is not a reliable diagnostic test for this.
Luckily there is a non invasive test that can help determine if there is the presence of hydrogen and methane predominant SIBO that is in the form of a breath test. This test takes about 3 hours to complete at home and needs a preparation diet a day in advance with a 12-hour fasting before the test.
The prep diet consists of:
- white jasmine rice
- clear broths
- and weak black coffee or black tea
The prep diet avoids:
- fruits, vegetables and juices
- green or herbal teas
- nuts, seeds, grain products (except plain steamed white rice)
- dairy products
- alcoholic beverages
- beans, herbs and spices
- sugars and condiments
- exercise and smoking for 1 hour prior to test and for the duration of the test
- antibiotics or antifungals should not be taken 2 weeks prior to the test
- colonoscopy, rectal enemas, or a barium swallow should not be done 2 weeks prior to test
- laxatives, high doses of vitamin C (> 2,000mg), magnesium (> 1,000mg), and probiotics should be stopped 4 days prior to test
- and non-essential supplements and medications, including probiotics, should be stopped on the day of the test
Test procedure includes:
- no food or drink (except water) is permitted until breath collections are over
- essential medications should be taken upon waking
- begin collecting breath samples an hour after waking
- collect a baseline sample
- prepare lactulose solution by mixing 1 cup of water with the lactulose provided in the test kit
- immediately drink the lactulose solution
- and lastly, collect a new breath sample every 20 minutes for the next 3 hours (9 more breath samples)
Results come to the prescribing practitioner within 7-10 business days.
SIBO Breath Test Instructions
SIBO Test Guide
Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Rezaie A, Buresi M, Lembo, A, Lin H, McCallum R, Rao S, Schmulson M, Valdovinos M, Zakko S, and M Pimentel. American Journal of Gastroenterology. Jan 2017. 112: 775-784.
Outcome of Breath Test in Adult Patients with Suspected Small Intestinal Bacterial Overgrowth.
Mattsson J, Minaya MT, Monegro M, Lebwohl B, Lewis SK, Green PHR, and R Stenberg. Gastroenterology and Hepatology From Bed to Bench. Aug 2017. 10(3): 168-172.