Every Breath Test You Take: Practical Advice on Breath Testing Used to Detect Small Intestinal Bacterial Overgrowth

Excerpt

The review by Drs. Massey and Wald, published in this issue of Digestive Diseases and Sciences [1], is a timely reminder regarding the availability and pitfalls of the use of noninvasive breath tests for the identification of small intestinal bacterial overgrowth (SIBO) in patients with nonspecific gastrointestinal symptoms. Massey and Wald have provided the evidence for their recommendation to strongly discourage performance of the lactulose hydrogen breath test due to the confounding influence of accelerated orocecal transit, including false positives manifesting as elevations of either breath hydrogen or methane. The authors identified important principles and approaches regarding the diagnosis of SIBO in Table 1 of their article. We provide here a practical format that can be used in the clinical setting or in the laboratory where the test is performed, as shown in the algorithm in Fig. 1.

…