SIBO Breath Test Interpretation


SIBO Breath Test Interpretation


Topics covered

1.Basics of breath testing

2.Preparation Diet prior to testing

3.Test result interpretation

4.Common patterns

5. Q&A

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NEW! All about SIBO Breath Test Interpretation. Webinar with Dr Nirala Jacobi, BHSc, ND (USA) – Medical Director,

Recorded Thursday, Oct 12, 2017
Please note: a link to this recorded webinar and the PDF slides will be sent out upon registration.

Learning objectives

  • Confidently interpret the nuances of hydrogen positive SIBO
  • Understand Methane positive SIBO vs IBS-C methane positive
  • When to consider hydrogen sulfide on a breath test result
  • When to retest your patient
  • What do rising hydrogen and falling methane mean on a retest
  • Plus Q+A with SIBO expert, Dr Nirala Jacobi


What is breath testing?

  • Stool test NOT accurate for SIBO
  • Breath test: assess bacterial fermentation over 90-100 minutes measures Methane and Hydrogen gas (not produced by humans)
  • SIBO-D = diarrhoea dominant:
  • E coli, Klebsiella, Proteus, Aeromonas (most common)
  • Produce hydrogen gas (H2)
  • SIBO-C = constipation dominant
  • Methanobrevibacter smithii produce methane gas (CH4)

Laboratories– how to be
a discerning practitioner

Important questions to ask

  •       Prep diet – how restrictive?
  •       open or closed sample collection system
  •       testing for hydrogen, methane, and CO2
  •       grams of test sugars
  •       Sample timing (eg 20 min vs 30 min) and length of test (2h vs 3h)

Prep Guidelines- what to avoid

Prep Diet

What test to order?

Interpreting the Results

  • Lactulose Test Results- positive
  • Lactulose and Glucose Breath Test Positive
  • Lactulose negative, Glucose positive
  • Methane (CH4) Positive
  • Methane conundrum
  • Methane positive IBS-C but negative for SIBO
  • Methane positive, negative SIBO
  • High methane followed by high hydrogen on re-test. Frequently seen- no need for alarm!
  • Fructose Positive
  • Fructose- timing matters!
  • High Baseline
  • Bad sampling
  • “Flatlining”
  • Lactulose “non-fermenters”?
  • Normal rise in the large intestine


Treatment – how long?


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