How is SIBO diagnosed?

The gold standard for diagnosing SIBO is aspiration (taking a sample) of small intestine contents during endoscopy. Obviously, this is quite invasive with some potential serious risks, and it also is quite expensive. That’s why SIBO breathing testing is how the majority of SIBO cases are diagnosed worldwide.

How SIBO test works

The SIBO breath test can be performed at home or in a practitioner’s office. If possible, home testing may be the preferred option for many because test day can be challenging. Some people don’t feel well after drinking the glucose or lactulose solution because it may trigger gas, bloating or other symptoms. Also, the test is long…two or three hours.

The testing procedure itself involves:

1.  A one or two day dietary prep before doing the SIBO breath test. The diet is not difficult, but does require some advanced planning. The prep diet involves consuming nothing but water, chicken, eggs, black coffee, and plain tea. The test taker may also use oils/fats and salt and pepper during the prep diet.

2.  Fast for 12 hours prior to starting the test.

3. Many people choose to start in the early morning after the required pretest fast of 12 hours. A baseline breath sample is collected via the breath test collection system. Then either the glucose or lactulose mixed in 8 ounces of water is consumed.

4. Following the ingestion of glucose or lactulose, a breath sample is collected every 15-20 minutes for 2-3 hours.
The collected breath samples are then shipped to the lab according to the lab instructions contained in the kit.

With testing being so complicated and complex, why test? Well currently there are four different types of SIBO, which we’ll address in another blog post. Each SIBO type requires a different treatment, so testing is imperative to choose the appropriate treatment. Also re-testing may be needed to assess the response to the treatment.

Finally, it is important to do testing with a knowledgeable SIBO provider, as the test interpretation has nuances. There are some basic guidelines about test interpretation, but a SIBO knowledgeable practitioner incorporates a patient’s history and symptoms, as well as the test’s limitations into the test result to guide interpretation. 

There are some additional tests that may be recommended during the evaluation for SIBO, even though they do not diagnose SIBO itself.

One is a complete stool analysis (like GI Effects by Genova Diagnostics). This test can inform us about how well the digestive system is working, if there are any infections (like parasites or yeast) present, and who are the main players of your large intestinal bacteria (your microbiome).

In addition, an organic acid test (OAT) may be recommended. An OAT will provide an assessment of nutritional markers, digestion markers, detoxification ability, and the intestinal microbiome metabolites. These tests are helpful in supporting the diagnosis of SIBO, but also may indicate if there is something besides SIBO causing symptoms or in addition to SIBO causing issues.

Lastly, in the previous blog post, I noted that the most common underlying issue causing SIBO is food poisoning. People with SIBO symptoms may or may not recall an incident of food poisoning in their past. There is a blood test, which if positive, indicates a 95% chance that SIBO is arising from food poisoning. This is important since it guides the provider in treatment, as well as provides information about prognosis.

If you think you may have SIBO, take the next step to enhance your health and well-being. Remember Vytal Health is here to help.

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