Hydrogen Breath Testing Frequently Asked Questions

Result Interpretation

Q: What does it mean when all values are low with one spike?

A: Hydrogen: Breathing two or three times before collecting the sample can cause this.
A: Methane: This is common; methane diffuses quickly which can cause this to happen.

Q: What does it mean when the values are all zeros (or all twos etc.)?

A: This is very common. Up to 5% of all SIBO tests are ‘‘flatliners’’
A: This can either be caused by levels of hydrogen sulfide or methane below our detection limits.

Q: What do high values throughout the test mean?

A: Hydrogen: Poor preparation or a condition such as gastroparesis.
A: Methane: This is Normal

Q: What does it mean when there is a high baseline followed by decreasing values?

A: Poor test preparation.

Q: What do low values followed by a peak at #6 or #7 mean?

A: This can be due to a faster transit time than our test cut-off time.
A: Because the average start of colonic activity is around 105 minutes.

Medications and Procedure Questions

Q: Which medications will affect the outcome of a hydrogen breath test?

A: PPIs (Proton Pump Inhibitors such as Prilosec, Nexium, and Prevacid)

• If the patient has been on a PPI for a while (a few months), the patient may stay on themedication and leave a note listing the medication in his/her kit when it’s sent back.
• If the patient takes it as needed or just started the medication, he/she should be off themedication for the preparation period and the day of the test.

A: H2 Blockers (such as Zantac, Pepcid, Tagamet)

• If the patient has been on H2 blockers for a while (a few months), the patient may stay on themedication and leave a note listing the medication in his/her kit when it’s sent back.
• If the patient takes it as needed or just started the medication, he/she should be off themedication for the preparation period and the day of the test.

A: Narcotics

• Do not take these the day of the test

A: Laxatives (such as Metamucil, Dulcolax, Ex-Lax)

• Stop taking one day before taking test

A: Antibiotics

• Stop taking 2 weeks before taking test

A: Probiotics

• Stop taking 5 days before taking test

Q: Which procedures / conditions will affect the outcome of a test?

A: Colonoscopies

• Must wait two weeks before taking test

A: Gastric Bypass surgery

• Will accelerate transit time, leave note in test kit

A: Gastroparesis

• Food will stay in stomach much longer, fermenting •May result in a high hydrogen baselin

Q: What about patients who have diabetes?

A: Patients with Type I: Basal insulin recommended no pre-meal insulin. Candy with sucrose/glucose can be used for low blood sugar levels. Only take Lactulose test.
A: Patients with Type II: Forgo medications day of test and start the test as early as possible in the morning.

Preparation Questions (Diet, Fasting, and Taking the Test)Dieting/Fasting

Q: Can I use seasonings during the restricted diet?

A: Salt and Pepper may be used in moderation.

Q: Can I use cooking oil (olive oil, Pam etc.) during the restricted diet?

A: Yes, very small amounts of cooking oil are acceptable. The type of oil used isn’t as important as the amount of oil used.

Q: Can I chew gum during the preparation period?

A: No, gum is not allowed during any part of the preparation period.

Q: Can I smoke during the preparation period?

A: No, smoking should be stopped a few hours before the test.

Q: I forgot to follow the diet properly, will this affect my test?

A: Yes, improper diet will show up in the baseline sample of your test. Too high of a value usually means a retake is required.

Q: I did not fast for the full 12 hours, will this affect my test?

A: Yes it can. It could show a high baseline or inconsistent values throughout the test.

Q: I forgot to take the baseline sample, can I continue with the test?

A: It depends, if you remembered to take the baseline within 15 minutes of the substrate, continue as usual. Record the time when the substrate was ingested and continue with the recommended timing of the test. If it was longer than 30 minutes, the test must be redone.

Q: What happens if I vomited during the test?

A: If it was early on in the test (two or three tubes into the test), the test must be redone.
A: If it was after tube #3, you will be fine; include a note explaining in test kit.

Q: What if I have to run to the bathroom during the test?

A: Mark down the time and leave a note in the test kit. This will affect your overall results.

Q: I sipped the substrate throughout the test. Will the test still be accurate?

A: No, the test must be redone.

Miscellaneous

Q: How common are SIBO test results that are all zeros?

A: Very common. Up to 5% of all SIBO tests are all zeros.

Q: Can I take a SIBO test while pregnant?

A: Yes, but you should wait until you are not pregnant for treatment of the test. The test itself is safe, but no medication can be given if the result is positive.

Q: Which substrate should I use: Glucose or Lactulose?

A: Glucose is a more specific substrate due to the fact that no human should be fermenting this substrate.
A: Lactulose gives a more complete picture of the intestinal tract, but also has a higher rate for false positives.

Q: What is the sensitivity/specificity of your SIBO test?

A: Since there is no gold standard for bacterial overgrowth testing, there is no way to calculate this value; however, patients with IBS have abnormal breath test results compared to normal, healthy patients by a factor of 10. If they have this abnormal breath test, they will also respond more favorably to antibiotic treatment.

Q: What is the difference between the substrates glucose and lactulose?

A: Lactulose is a synthetic disaccharide that cannot be digested or absorbed by human cells. Many providers use lactulose when administering the breath test for SIBO as they feel it gives a complete profile of the small intestine and can identify distal overgrowth. Glucose is a simple monosaccharide.

Some providers feel that the glucose substrate can be restrictive when doing a breath test for SIBO as it is absorbed very quickly and may only be able to identify overgrowth in the proximal region of the small intestine.

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