The Hydrogen Breath Test (or HBT) is used as a clinical medical diagnosis for people with Irritable Bowel Syndrome (IBS) and common food intolerances. The test is simple, non-invasive, and is performed after a short period of fasting (typically 8-12 hours). When testing for conditions like Lactose Intolerance, Fructose Intolerance and Small Intestinal Bacterial Overgrowth (SIBO), studies have demonstrated the importance of Hydrogen (H2) and Methane (CH4) production. These indicated that more than 30% of healthy adult subjects produce Methane in addition to – or instead of – Hydrogen. This increases the ability for clinicians to review the most comprehensive results to best aid them in their decision of how to best relieve patients IBS or other gastrointestinal symptoms.
How to order the test
To order the test, please click on the button below and use the Patient Login with these details:
- User: oliverfrey
- Password: client
What is Small Intestinal Bacterial Overgrowth (SIBO):
Like the name suggests, SIBO is where bacteria enter your small intestine and begin to colonise. Studies have indicated that potentially up to 80% of patients with IBS may in fact have SIBO, which a Hydrogen/Methane Breath Test can easily, and non-invasively, help determine.
Common symptoms and reasons to test for SIBO include:
Nausea, flatulence, diarrhoea, constipation, malnutrition, Irritable Bowel Syndrome (IBS), Irritable Bowel Disease (IBD), Leaky Gut Syndrome, Chronic Fatigue Syndrome, Acid Reflux, Rosacea, Restless Leg Syndrome (RLS), Fibromyalgia, Gastroeseophageal Reflux Disease (GERD), Coeliac Disease & Diverticulitis.
Risk factors for the development of bacterial overgrowth include:
Dysmotility, anatomical disturbances in the bowel, including fistulae, diverticula and blind loops created after surgery, and resection of the ileocecal valve, gastroenteritis induced alterations to the small intestine, as well as the use of certain medications, including proton pump inhibitors.
What does testing Hydrogen and Methane tell you?
When some bacteria digest and ferment food substances, they produce acids, water and gases. The major gases which are produced by bacteria include carbon dioxide, hydrogen, methane and small concentrations of aromatic gases. Carbon dioxide is produced by all cells during metabolism, but only bacteria can produce hydrogen and methane, as metabolic by-products, and this is accomplished primarily by bacteria that thrive in the absence of oxygen. So, if either hydrogen or methane are produced biologically, it tells us that some food substance is exposed to bacterial fermentation.
Most of the bacteria contained in food are killed by stomach acid, so the small intestine usually has very little bacteria; however, bacteria colonise in high concentrations in those with SIBO. Consequently, this can interfere with the absorption of nutrients.
Gases which are produced in the colon are reabsorbed and equilibrated with the blood. They appear in the lung and cross the capillary membrane into the alveoli, from which they are expired during breathing. This alveolar air can then be collected and analysed.
Difference Between Lactulose and Glucose for SIBO Breath Testing
The two types of sugar substrates used for breath testing are lactulose and glucose. When you ingest lactulose or glucose bacteria feeds on these sugars and produces gases like hydrogen and methane which we are then able to measure in a breath test. But, there are some key differences between both sugar substrates.
So, what’s the difference between the 2 types of sugars used for testing?
Lactulose Tests: Lactulose is a sugar that humans cannot digest, only bacteria can. Lactulose does not get absorbed and reaches the end of the small intestine which is where SIBO is thought to be more common. This allows us to get a picture of the whole small intestine.
- Lactulose will diagnose SIBO at the end of the small intestine
- Most common sugar used in breath testing
Glucose Tests: Glucose is a sugar that is absorbed by humans and bacteria. Glucose is absorbed higher up in the small intestine (first 3 feet of small bowel) which shows us if SIBO is present in the upper part of the small intestine.
Unfortunately, this test does not show us if SIBO is present at the end of the small intestine since it is absorbed so quickly. This is why most doctors use lactulose.
- Doesn’t diagnose SIBO at the end of the small intestine
- If someone tests positive with glucose we know that they for sure have SIBO higher up in the intestines
The best SIBO test to use is the 3-hour lactulose test.
There is a benefit if you are willing to do both glucose and lactulose breath tests because you will be able to tell with the glucose test how high up the bacteria are, but you should always do the lactulose test to measure the whole length of the small intestine.