SIBO test: What should be considered

Do you suspect you may be suffering from SIBO—a bacterial overgrowth in the small intestine? Do you regularly experience SIBO symptoms such as bloating after eating, gas, abdominal pain, or nausea? Then it might be advisable to take a SIBO breath test. This simple test can not only determine whether SIBO is present, but also what type it is. This is crucial for choosing the right treatment strategy. In this article, you'll learn more about how this test works and how to interpret the results. 

SIBO is a bacterial overgrowth in the small intestine. To diagnose this condition, a SIBO breath test can be performed. This test measures gas production through breath samples taken after drinking a sugar solution— lactulose or glucose. These samples are taken every 20 minutes for up to 180 minutes. The samples are then sent to a laboratory for further analysis. Two types of gases are examined: hydrogen and methane. The results show which gases are produced, when they are produced, and to what extent. This can provide clues that may indicate SIBO. 

Two types of sugar solutions can be chosen for the SIBO breath test: lactulose or glucose. Of the two, lactulose is the most commonly used by SIBO specialists. There are several reasons for this: 

  

With glucose, distal SIBO (bacterial overgrowth in the last part of the small intestine) is more likely to be missed because it can be absorbed further up the digestive tract. 

Lactulose cannot be absorbed into the intestinal system and is therefore able to measure bacterial overgrowth throughout the small intestine, even if the overgrowth is located in the last part of the small intestine. 

Lactulose has no effect on blood sugar levels and is therefore a better choice for diabetics. 

  

However, these reasons do not mean that the glucose test is completely worthless. In certain cases, a glucose test can even be used to confirm an inconclusive lactulose breath test result. 

Ordering the SIBO test:

You can order a SIBO breath test here on the website. On the order page, you can choose lactulose , glucose, or a combination of both. For more information on the other tests, we recommend consulting a therapist. 

  

Once you have the test in hand, you should follow these steps to prepare properly: 

1 month before the test:

Wait at least 4 weeks before taking the test, after: 

antibiotic treatment, a colonoscopy, Colonic irrigation, 

or an X-ray examination with oral contrast medium. 

1 week before the test:

Stop taking: 

Prebiotics, probiotics and probiotic products (e.g. yogurt and fermented products) 

Antifungals 

Plant-based antimicrobials 

24-48 hours before the test:

 Follow the preparatory diet starting 24 hours before the test—or 48 hours if constipation is present. The diet is explained in more detail in the enclosed instructions. 

Stop taking: 

laxative 

Antacids 

dietary supplements 

12 hours before the test:

 Fast for 12 hours before the test, e.g., overnight. Do not eat or drink anything other than water before and during the test. If possible, and only in consultation with your physician, avoid non-essential medications. 

1 hour before and during the test: 

Brush your teeth only with water (without toothpaste). 

Do not smoke on the day of the test or during the test, including passive smoking. 

Get up at least one hour before the test and do not sleep during the test. 

No sporting activities before or during the test. 

For further details, please refer to the instructions provided with the SIBO test. 

  

When you're ready to perform the SIBO test, you can remove the glass tubes from the package and prepare the sugar solution. It's important to follow the instructions on the accompanying leaflet step by step. 

  

After a baseline measurement, you drink the sugar solution and then take a new breath sample every 20 minutes. After 180 minutes, the final sample is taken, and you are finished with the test. You can return the tubes to the packaging for return shipping. After you have provided all the necessary information, you can return the package to the laboratory for further analysis. 

Once the lab has completed the analysis, you will receive the results via email. The results will be presented as a graph with associated data. Please note the following points: 

  

Is there an increase in hydrogen gas, methane gas, or a combination of both before 120 minutes (cut-off value for gas production in the small or large intestine)? 

Is this increase significant compared to the reference values? 

What is the shape of the curve: an increase sooner or later? 

  

Based on these points, statements about the situation can be made. It is recommended to do this together with a specialist. Doctor or therapist so that a targeted treatment plan can be created. 

  

If you would like to learn how to interpret the result of a SIBO breath test and how to develop a personal treatment plan based on this result, we recommend our Gut Program from All Ways Healthy Netherlands.

  

This online learning program is specifically designed to help you improve your intestinal symptoms on your own.