Small intestinal bacterial overgrowth (SIBO) and intestinal methanogenic overgrowth (IMO) are two common conditions that cause chronic digestive symptoms like bloating, abdominal pain, gas, constipation, and diarrhea. SIBO breath testing is available to diagnose SIBO and IMO. Until recently, breath testing technology could only measure two of the three predominant gases produced by the microbiome. The recent development of the trio-smart breath test ensures a more accurate diagnosis of SIBO and IMO.

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What is the trio-smart SIBO Breath Test from Gemelli Biotech?

trio-smart is the only three-gas breath test that measures the three primary fermented gases produced in the gut by the bacteria and archaea colonizing it. By measuring hydrogen (H2), methane (CH4), and hydrogen sulfide (H2S), trio-smart aids in the diagnosis of hydrogen- and hydrogen sulfide-SIBO and intestinal methanogenic overgrowth (IMO).

Specific symptoms and conditions are associated with abnormal levels of each gas. Overgrowth of bacteria in the small intestine causes an elevation of hydrogen gas, which is diagnostic of hydrogen-SIBO. Archaea, single-celled bacteria-like organisms, are responsible for methane production; elevated methane is diagnostic for intestinal methanogenic overgrowth (IMO). Certain microorganisms in the digestive tract consume hydrogen gas to produce hydrogen sulfide. High levels of hydrogen sulfide are indicative of hydrogen sulfide-SIBO. (1)

The trio-smart test is a doctor-ordered mail-in breath test collected at home by the patient. After drinking a glucose- or lactulose-containing solution, the patient performs breath sample collections at 15-minute timed intervals. Organisms in the small intestine ferment the glucose or lactulose sugar and produce H2, CH4, and H2S gases in the process. These gases diffuse into systemic circulation from the intestines and are expired through the lungs. An overgrowth of bacteria or archaea in the small intestine results in an elevation of at least one gas type on the test, which is diagnostic for SIBO and/or IMO. The test takes two hours to complete, and a total of nine breath samples are collected. (2)

What is the Difference Between a Lactulose and Glucose SIBO Breath Test?

A SIBO breath test involves the consumption of either a lactulose or glucose solution at the beginning of the test. The ordering provider can order either a lactulose or glucose breath test through Gemelli Biotech.

A glucose and lactulose breath test each has its own pros and cons and can be useful for different clinical needs. Because glucose does not require a prescription, glucose tests may be ordered by any healthcare provider regardless of prescribing rights. A prescribing doctor must prescribe the lactulose solution needed for the lactulose breath tests. Because glucose is readily absorbed in the small intestine, glucose tests can be used to diagnose SIBO and IMO in the early portions of the small intestine. However, glucose tests can result in false negative results if the bacterial overgrowth is present in the distal portions of the intestines. Humans do not absorb lactulose, so lactulose tests are better for diagnosing SIBO and IMO in the distal parts of the small intestine and large intestine. (2)

Which Patients is the trio-smart Test Best Used For?

The trio-smart test can be used to diagnose SIBO in patients who are experiencing classic SIBO symptoms. The most prominent symptom of SIBO is bloating. Other digestive symptoms common in SIBO include abdominal pain, heartburn, nausea, gas, and diarrhea. Patients with IMO express similar symptoms to SIBO: bloating, abdominal pain, and gas. Whereas hydrogen and hydrogen sulfide gases predominantly cause diarrhea, constipation is primarily associated with excess methane. (1)

trio-smart can also be used to monitor treatment progress and to confirm the eradication of SIBO and IMO.

How to Use the trio-smart Test from Gemelli Biotech in Clinic

The trio-smart test requires dietary restrictions for a day prior to sample collection. Patients with chronic constipation and slowed intestinal motility may benefit from a two-day preparation diet to yield more accurate test results. Patients should also avoid certain medications and supplements (e.g., antimicrobials, laxatives,  probiotics) for up to four weeks before testing.

The trio-smart can diagnose and monitor H2-SIBO, H2S-SIBO, and IMO. A SIBO breath test is considered positive if H2 levels rise above 20 ppm from baseline within 90 minutes, CH4 levels measure at least 10 ppm at any point during the test, or H2S levels measure at least 3 ppm at any point during the test. (2, 3)

trio-smart results should be used to guide treatment recommendations for eradication. Antibiotic therapy is indicated for eradicating the bacteria and archaea responsible for symptoms. Research shows that different antibiotic combinations are more effective for treating H2-SIBO versus IMO. Rifaximin appears to provide optimal benefit in patients with SIBO, whereas rifaximin combined with another antibiotic (typically neomycin or metronidazole) results in a higher eradication rate of methanogen overgrowth. The use of bismuth subsalicylate and antibiotics, like rifaximin, appear to be effective in reducing H2S production and digestive symptoms. (3, 4)

Summary

The trio-smart breath test is the only SIBO test on the market that measures hydrogen, methane, and hydrogen sulfide gas levels. Measurement of all three gases aids in diagnosing and differentiating between SIBO and IMO, which commonly cause uncomfortable, chronic digestive symptoms. Utilizing the trio-smart breath test, healthcare providers can make the best treatment decisions and monitor eradication progress to resolve dysbiosis and related gastrointestinal symptoms.