Glucose and lactulose are the most common substrates used in breath testing for SIBO.

An increase in hydrogen concentrations of в‰Ґ20 ppm from baseline within 90-120 minutes is recommended to be diagnostic of SIBO.

The breath samples should be measured for hydrogen and methane.

Administering 75-g glucose or 10-g lactulose, either taken with or followed by 1 cup of water (в€ј250 mL) is recommended.In addition, during the breath test, patients should avoid smoking and minimize physical exertion.The day before the breath test, fermentable foods (e.g., complex carbohydrates) should be avoided, and patients should fast for 8вЂ“12 hours.Before breath testing, it is recommended that patients avoid the use of antibiotics for 4 weeks and avoid promotility agents and laxatives for at least 1 week.Performing and interpreting breath test results вЂ“ The North American consensus

If hydrogen and methane gases can be detected in breath samples, it points out another source such as the fermentation of carbohydrates by microbes in the gut, their subsequent absorption into the bloodstream, and their expiration through the lungs. Human cells are incapable of producing hydrogen and methane gases, and this fact forms the basis of breath tests. Recommendation 3: The guideline suggests testing for SIBO using glucose hydrogen or lactulose hydrogen breath testing in symptomatic patients ( abdominal pain, gas, bloating, and/or diarrhoea) with previous luminal abdominal surgery. Recommendation 2: The guideline suggests using glucose hydrogen or lactulose hydrogen breath testing for the diagnosis of SIBO in symptomatic patients with suspected motility disorders. Recommendation 1: The guideline suggests the use of breath testing (glucose hydrogen or lactulose hydrogen) for the diagnosis of SIBO in patients with IBS. Hence, in a patient presenting with unexplained abdominal pain, gas, bloating, diarrhoea, and/or malabsorptive symptoms, the symptoms should be evaluated along with risk factors for SIBO and any treatment history.

No single symptom can be specifically attributed to SIBO as the symptoms of SIBO often overlap with IBS, functional diarrhoea, functional dyspepsia, or bloating. Some patients may also experience fatigue and poor concentration.In severe cases, nutritional deficiencies including vitamin B12, vitamin D, and iron deficiencies can be found.Abdominal pain, bloating, gas, distension, flatulence, and diarrhoea.Most common symptoms in patients with SIBO: Also, the microbial overgrowth must result in specific GI signs and/or symptoms.ДЇor threshold cut-off of a positive culture, the North American Consensus suggests considering a bacterial colony count of в‰Ґ10 3 colony-forming units per millilitre (CFU/mL) in a duodenal/jejunal aspirate as a diagnostic of SIBO.ДЇor breath testing, a rise in exhaled hydrogen of at least 20 parts per million (ppm) above baseline within 90 minutes of oral ingestion of either 75 g of glucose or 10 g of lactulose, is diagnostic of SIBO. There must be measurable and excessive bacterial burden within the small bowel. SIBO is defined as a clinical syndrome of gastrointestinal (GI) symptoms caused by the presence of excessive numbers of bacteria within the small intestine.

Small bacterial overgrowth