How to Interpret your SIBO Breath Test Results
SIBO SUSPECTED
If SIBO is suspected, this indicates that there is an overgrowth of bacteria in your small intestine. Follow up with your referring practitioner is recommended. Your referring practitioner may suggest a course of antibiotics to reduce the level of bacteria in your small intestine.
The solution that is more commonnly used for testing is a synthetic sugar. Because of the composition of this testing solution, there are no naturally occurring enzymes available in the digestive system to break up this sugar for absorption. For this reason, the advantage is that it travels intact all the way through the small intestine and can pick up an excessive amount of bacteria in the proximal, mid, and distal portion of the small intestine.
The typical time is takes for this testing solution to travel through the intestinal tract and reach the colon is ~90 minutes. A rise in values (above your baseline measurement) of at least 20ppm within 90 minutes suggests that an excessive number of bacteria in the small intestine metabolised the testing substrate (similar to what happens when you eat your food, particularly carbohydrates)(1).
After ~90 minutes, the solution passes into the colon and is fermented by normal colonic bacteria. The values on your report will typically be higher after 90 minutes as there is a much larger volume of bacteria in the colon.
EVIDENCE OF INTESTINAL METHANOGEN OVERGROWTH
The indicates that there is too much methane gas been produced by methanogens (a type of microorganism found throughout the intestinal tract). Follow up with your referring practitioner is recommended who will determine if treatment is required.
The current North American consensus recommends that a methane measurement of greather than 10ppm at any point during the test is diagnostic of methanogen overgrowth(2).
What is Intestinal Methanogen Overgrowth ‘IMO’? Trying to keep it simple, methanogens are not bacteria but belong to a domain called archaea. Methanogens may also overgrow in the colon and not just the small intestine (unlike SIBO)(1).
Gas dynamics: Bacteria produce hydrogen gas. Methanogens use 4 x units of Hydrogen to make 1 x unit of methane gas.
Approximately 30-50% (6) of healthy people have methanogens in their digestive tract and they cause no issues for most people. However, in some people the methanogens can overgrow producing too much methane gas.
Methane gas can slow down intestinal transit (5). It has been shown that a positive methane breath test is associated with constipation, flatulence, and bloating. Higher levels of methane correlate with greater severity of constipation (3,4).
SIBO NOT SUSPECTED
This indicates that there was no rise in hydrogen or methane measurements outside of the reported reference ranges; the measurements for your test were normal. We still advise to consult with your referring practitioner for follow-up.
1) Pimentel, M., Saad, R., Long, M. and Rao, S., 2020. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. American Journal of Gastroenterology, 115(2), pp.165-178.
2) Rezaie, A., Buresi, M., Lembo, A., Lin, H., McCallum, R., Rao, S., Schmulson, M., Valdovinos, M., Zakko, S. and Pimentel, M., 2017. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. American Journal of Gastroenterology, 112(5), pp.775-784.
3) Kunkel, D., Basseri, R., Makhani, M., Chong, K., Chang, C. and Pimentel, M., 2011. Methane on Breath Testing Is Associated with Constipation: A Systematic Review and Meta- nalysis. Digestive Diseases and Sciences, 56(6), pp.1612-1618.
4) Chatterjee, S., Park, S., Low, K., Kong, Y. and Pimentel, M., 2007. The Degree of Breath Methane Production in IBS Correlates With the Severity of Constipation. The American Journal of Gastroenterology, 102(4), pp.837-841.
5) Pimentel, M., Lin, H., Enayati, P., van den Burg, B., Lee, H., Chen, J., Park, S., Kong, Y. and Conklin, J., 2006. Methane, a gas produced by enteric bacteria, slows intestinal transit and augments small intestinal contractile activity. American Journal of Physiology-Gastrointestinal and Liver Physiology, 290(6), pp.G1089-G1095.
6) Triantafyllou, K., Chang, C. and Pimentel, M., 2014. Methanogens, Methane and Gastrointestinal Motility. Journal of Neurogastroenterology and Motility, 20(1), pp.31-40.
