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March 14, 2023

How to Use the SIBO/IMO Breath Tests from Commonwealth Diagnostics in Clinic

Medically Reviewed by
Updated On
September 17, 2024

Small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO) commonly cause digestive symptoms like bloating, abdominal pain, and changes in bowel movements. SIBO and IMO are defined as an over-accumulation of bacteria and archaea, respectively, in the small intestine. Research has concluded that up to 36 million Americans suffer from SIBO. At-home breath testing can diagnose SIBO and IMO to support appropriate treatment recommendations for SIBO/IMO-related symptoms.

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What is the SIBO/IMO Glucose Breath Test from Commonwealth Diagnostics International?

The SIBO/IMO glucose breath test utilizes a glucose substrate to measure gases produced by bacteria and archaea in the small intestine to diagnose SIBO and IMO. Bacteria and archaea ferment glucose as it travels through the small intestine before it is absorbed into the bloodstream. This fermentation produces hydrogen and methane gases, which are absorbed into circulation and exhaled through the lungs. After drinking the glucose solution, the patient performing the test will collect a series of breath samples at 15-minute timed intervals. The test takes 2 hours and 15 minutes to complete, and a total of 10 breath samples are collected during the test. Elevated gas levels measured in the breath reflect SIBO and/or IMO present in the first 2-3 feet of the small intestine.

Because glucose is absorbed by the small intestine, the glucose breath test cannot detect SIBO or IMO in the more distal portions of the small intestine. However, because of this, the glucose breath test is considered to produce fewer false positives than the lactulose breath test. The glucose breath test is also an alternative option for patients with a lactulose allergy who cannot perform the lactulose version of the test. (1)

What is the SIBO/IMO Lactulose Breath Test from Commonwealth Diagnostics International?

The SIBO/IMO lactulose breath test is identical to the glucose breath test, except that the patient drinks a lactulose solution at the beginning of the test. A lactulose breath test can diagnose SIBO and IMO in the small and large intestines because lactulose is not absorbed in the digestive tract (1). The lactulose breath test is also 2 hours and 15 minutes long, and the patient collects a total of 10 breath collections. The doctor ordering this test must have prescribing rights to prescribe the patient the lactulose included in the test kit.

Which Patients are the SIBO/IMO Breath Tests Best Used For?

SIBO/IMO breath bests can aid in diagnosing SIBO and IMO in patients experiencing typical digestive symptoms associated with SIBO and IMO. Bloating, abdominal pain, gas, constipation, diarrhea, and nutrient deficiencies are common signs and symptoms that SIBO and/or IMO are present. Research also suggests an increased risk and prevalence of SIBO in patients with irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease. (2)

However, with increased awareness of SIBO and more research being performed, ample evidence suggests that SIBO is associated with symptoms and medical conditions outside of the digestive tract. Identifying and treating SIBO/IMO in patients with the following medical conditions may help to get to the root cause of the disease:

Metabolic Syndrome

Emerging evidence supports that the gut microbiome helps to regulate metabolism, fat storage, and energy balance. Shifts in the normal intestinal microbiome composition have been connected to metabolic syndrome. Additionally, more recent evidence has shown that SIBO occurs more frequently in obese patients than non-obese patients. (2)

Gastroparesis, or slowed intestinal transit, is a consequence of diabetes caused by nerve damage. Slowed intestinal motility is a risk factor for SIBO, and studies have found an increased risk of SIBO among patients with type 2 diabetes. (2)

Rheumatologic Diseases

Intestinal dysmotility and dysbiosis are contributing factors to many rheumatologic and autoimmune diseases. SIBO has been documented to have higher prevalence rates in patients with systemic sclerosis, Behçet's disease, and bowel-associated dermatosis-arthritis syndrome. (2)

Dermatologic Diseases

The "skin-gut axis" refers to the bidirectional relationship between the gut microbiome and skin health. Disruptions in the healthy microbiome and the development of SIBO have been linked to skin conditions, including rosacea, pyoderma faciale, and psoriasis. (2)

Other Diseases

Impaired intestinal motility, slowed stomach emptying, and constipation are early signs of Parkinson's disease (PD). Gut motor dysfunctions are known to predispose an individual to SIBO, and IMO is highly correlated with chronic constipation. Studies have estimated up to 67% prevalence rate of SIBO in patients with diagnosed PD. (2)

Pro-inflammatory responses that contribute to liver disease have been measured in SIBO patients, and preliminary studies have concluded that treatment of SIBO in patients with non-alcoholic fatty liver disease (NAFLD) results in reduced markers of liver inflammation. (2)

How to Use the SIBO/IMO Breath Tests from Commonwealth Diagnostics International in Clinic

Patients must follow test preparation instructions before completing the glucose and lactulose SIBO/IMO breath tests. Patients should discontinue antibiotic, laxative, and promotility drugs and supplements up to four weeks before taking the test. Smoking and vaping 24 hours before and during the test can interfere with test accuracy. Additionally, patients should not sleep or exercise during the testing period.

Dietary restrictions are required 24 hours before test collection. The patient should eat only plain poultry, beef, pork, seafood, eggs, and white rice for 12 hours, followed by a 12-hour fasting period in which only water is permitted. The patient may return to their regular diet after completing the test.

The lactulose breath test is contraindicated for patients with a documented lactulose allergy. Caution should be taken ordering SIBO/IMO breath tests for patients with poorly-controlled diabetes, as blood sugar changes can occur with fasting and with drinking the glucose and lactulose solutions.

Per the North American Consensus, SIBO is diagnosed by a rise in hydrogen gas of at least 20 ppm by 90 minutes, and IMO is diagnosed by a methane level of at least 10 ppm at any time point during the test. It is possible to have co-existing SIBO and IMO. (1)

Research supports the treatment of SIBO and IMO with prescription antibiotics and/or antimicrobial herbal supplements. Probiotics have also been shown to reduce the bacterial burden and alleviate SIBO symptoms effectively. Dietary modifications are also commonly implemented during SIBO treatment protocols to palliate digestive symptoms frequently triggered by eating. (3)

The SIBO/IMO tests can be used to monitor treatment progress and confirm SIBO/IMO eradication after antibiotic therapy is completed. Waiting to retest four weeks after completing antibiotic treatment is generally not recommended for repeat tests, but all other preparatory instructions apply.

Summary

Small intestinal bacterial overgrowth and intestinal methanogen overgrowth are common conditions characterized by bacterial and archaeal overgrowth in the small intestine. Undiagnosed and untreated SIBO and IMO can cause disruptive digestive symptoms and contribute to symptoms unrelated to the digestive tract. Convenient at-home breath tests that diagnose SIBO and IMO help with treatment plan decision-making and monitoring.

Small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO) are conditions that may contribute to digestive symptoms like bloating, abdominal discomfort, and changes in bowel habits. SIBO and IMO involve an over-accumulation of bacteria and archaea, respectively, in the small intestine. Research suggests that up to 36 million Americans may experience SIBO. At-home breath testing can help identify SIBO and IMO, which may support appropriate management of related symptoms.

[signup]

What is the SIBO/IMO Glucose Breath Test from Commonwealth Diagnostics International?

The SIBO/IMO glucose breath test uses a glucose substrate to measure gases produced by bacteria and archaea in the small intestine, which can help identify SIBO and IMO. Bacteria and archaea ferment glucose as it travels through the small intestine before it is absorbed into the bloodstream. This fermentation produces hydrogen and methane gases, which are absorbed into circulation and exhaled through the lungs. After drinking the glucose solution, the person performing the test will collect a series of breath samples at 15-minute intervals. The test takes 2 hours and 15 minutes to complete, and a total of 10 breath samples are collected during the test. Elevated gas levels measured in the breath may indicate the presence of SIBO and/or IMO in the first 2-3 feet of the small intestine.

Because glucose is absorbed by the small intestine, the glucose breath test may not detect SIBO or IMO in the more distal portions of the small intestine. However, because of this, the glucose breath test is considered to produce fewer false positives than the lactulose breath test. The glucose breath test is also an alternative option for individuals with a lactulose allergy who cannot perform the lactulose version of the test. (1)

What is the SIBO/IMO Lactulose Breath Test from Commonwealth Diagnostics International?

The SIBO/IMO lactulose breath test is similar to the glucose breath test, except that the individual drinks a lactulose solution at the beginning of the test. A lactulose breath test can help identify SIBO and IMO in the small and large intestines because lactulose is not absorbed in the digestive tract (1). The lactulose breath test is also 2 hours and 15 minutes long, and the individual collects a total of 10 breath samples. The healthcare provider ordering this test must have prescribing rights to prescribe the lactulose included in the test kit.

Which Patients are the SIBO/IMO Breath Tests Best Used For?

SIBO/IMO breath tests can aid in identifying SIBO and IMO in individuals experiencing typical digestive symptoms associated with these conditions. Bloating, abdominal discomfort, gas, constipation, diarrhea, and nutrient absorption issues are common signs and symptoms that may suggest the presence of SIBO and/or IMO. Research also suggests an increased risk and prevalence of SIBO in individuals with irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and celiac disease. (2)

With increased awareness of SIBO and ongoing research, evidence suggests that SIBO may be associated with symptoms and medical conditions outside of the digestive tract. Identifying and managing SIBO/IMO in individuals with the following medical conditions may help address underlying issues:

Metabolic Syndrome

Emerging evidence supports that the gut microbiome may play a role in regulating metabolism, fat storage, and energy balance. Changes in the normal intestinal microbiome composition have been connected to metabolic syndrome. Additionally, more recent evidence has shown that SIBO may occur more frequently in individuals with obesity than those without. (2)

Gastroparesis, or slowed intestinal transit, is a consequence of diabetes caused by nerve damage. Slowed intestinal motility is a risk factor for SIBO, and studies have found an increased risk of SIBO among individuals with type 2 diabetes. (2)

Rheumatologic Diseases

Intestinal dysmotility and dysbiosis are contributing factors to many rheumatologic and autoimmune diseases. SIBO has been documented to have higher prevalence rates in individuals with systemic sclerosis, Behçet's disease, and bowel-associated dermatosis-arthritis syndrome. (2)

Dermatologic Diseases

The "skin-gut axis" refers to the bidirectional relationship between the gut microbiome and skin health. Disruptions in the healthy microbiome and the development of SIBO have been linked to skin conditions, including rosacea, pyoderma faciale, and psoriasis. (2)

Other Diseases

Impaired intestinal motility, slowed stomach emptying, and constipation are early signs of Parkinson's disease (PD). Gut motor dysfunctions are known to predispose an individual to SIBO, and IMO is highly correlated with chronic constipation. Studies have estimated up to 67% prevalence rate of SIBO in individuals with diagnosed PD. (2)

Pro-inflammatory responses that may contribute to liver disease have been measured in SIBO patients, and preliminary studies have suggested that managing SIBO in individuals with non-alcoholic fatty liver disease (NAFLD) may result in reduced markers of liver inflammation. (2)

How to Use the SIBO/IMO Breath Tests from Commonwealth Diagnostics International in Clinic

Patients must follow test preparation instructions before completing the glucose and lactulose SIBO/IMO breath tests. Patients should discontinue antibiotic, laxative, and promotility drugs and supplements up to four weeks before taking the test. Smoking and vaping 24 hours before and during the test can interfere with test accuracy. Additionally, patients should not sleep or exercise during the testing period.

Dietary restrictions are required 24 hours before test collection. The patient should eat only plain poultry, beef, pork, seafood, eggs, and white rice for 12 hours, followed by a 12-hour fasting period in which only water is permitted. The patient may return to their regular diet after completing the test.

The lactulose breath test is not recommended for individuals with a documented lactulose allergy. Caution should be taken when ordering SIBO/IMO breath tests for individuals with poorly-controlled diabetes, as blood sugar changes can occur with fasting and with drinking the glucose and lactulose solutions.

Per the North American Consensus, SIBO is identified by a rise in hydrogen gas of at least 20 ppm by 90 minutes, and IMO is identified by a methane level of at least 10 ppm at any time point during the test. It is possible to have co-existing SIBO and IMO. (1)

Research supports the management of SIBO and IMO with prescription antibiotics and/or antimicrobial herbal supplements. Probiotics have also been shown to help reduce the bacterial burden and may alleviate SIBO symptoms. Dietary modifications are also commonly implemented during SIBO management protocols to help manage digestive symptoms frequently triggered by eating. (3)

The SIBO/IMO tests can be used to monitor management progress and assess SIBO/IMO status after antibiotic therapy is completed. Waiting to retest four weeks after completing antibiotic treatment is generally not recommended for repeat tests, but all other preparatory instructions apply.

Summary

Small intestinal bacterial overgrowth and intestinal methanogen overgrowth are conditions characterized by bacterial and archaeal overgrowth in the small intestine. Undiagnosed and unmanaged SIBO and IMO can contribute to disruptive digestive symptoms and may be associated with symptoms unrelated to the digestive tract. Convenient at-home breath tests that help identify SIBO and IMO can assist with management plan decision-making and monitoring.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on this website.

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Lab Tests in This Article

1. Rezaie, A., Buresi, M., Lembo, A., et al. (2017). Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. The American Journal of Gastroenterology, 112(5), 775–784. https://doi.org/10.1038/ajg.2017.46

2. Losurdo, G., D’Abramo, F., Indellicati, G., et al. (2020). The Influence of Small Intestinal Bacterial Overgrowth in Digestive and Extra-Intestinal Disorders. International Journal of Molecular Sciences, 21(10), 3531. https://doi.org/10.3390/ijms21103531

3. Achufusi, T.G., Kachroo, P., Zamora, E., et al. (2020). Small Intestinal Bacterial Overgrowth: Comprehensive Review of Diagnosis, Prevention, and Treatment Methods. Cureus. https://doi.org/10.7759/cureus.8860

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