Outcome of breath tests in adult patients with suspected small intestinal bacterial overgrowth.

Johanna Mattsson, Maria Teresa Minaya, Milka Monegro, Benjamin Lebwohl, Suzanne K. Lewis, Peter H.R. Green, Reidun Stenberg




Breath testing is used to detect small intestinal bacterial overgrowth (SIBO) by measuring hydrogen and methane produced by intestinal bacteria.  


The aim was to investigate breath test outcomes in patients with suspected SIBO and indicative symptoms of SIBO, diagnosed by breath testing.


A retrospective cross sectional study carried out at Celiac Disease Center at Columbia University in New York of 311 patients undergoing breath testing.


50 % had a positive lactulose breath result and 37 % had a positive glucose breath result (p=0.036). The most common symptom of the patients was bloating. In total 46 % had a positive breath test: 18 % positive for methane, 24 % positive for hydrogen and 4 % positive for both gases (p=0.014). The only statistically significant predictor of positive glucose breath test was increased gas (p=0.028).


Lactulose breath test was more often positive than glucose breath test. Positivity for hydrogen was more common than methane. Bloating was the most frequently perceived symptom. The only statistically significant symptom for a positive glucose breath test was increased gas.


Small intestinal bacterial overgrowth; Lactulose breath test; Glucose breath test; Gastrointestinal symptoms; Adults.


Quigley EM, Quera R. Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics, and probiotics. Gastroenterology 2006 Feb;130(2 Suppl 1):S78-90.

Khoshini R, Dai SC, Lezcano S, Pimentel M. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci 2008 Jun;53(6):1443-1454.

Bures J, Cyrany J, Kohoutova D, Forstl M, Rejchrt S, Kvetina J, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol 2010 Jun 28;16(24):2978-2990.

Bohm M, Siwiec RM, Wo JM. Diagnosis and management of small intestinal bacterial overgrowth. Nutr Clin Pract 2013 Jun;28(3):289-299.

Hellstrom P. Bakteriell överväxt. In: Nyhlin H, editor. Medicinska mag- och tarmsjukdomar. 1st ed. Helsingborg: Studentlitteratur; 2008. p. 333-336.

Siniewicz-Luzenczyk K, Bik-Gawin A, Zeman K, Bak-Romaniszyn L. Small intestinal bacterial overgrowth syndrome in children. Prz Gastroenterol 2015;10(1):28-32.

Miazga A, Osinski M, Cichy W, Zaba R. Current views on the etiopathogenesis, clinical manifestation, diagnostics, treatment and correlation with other nosological entities of SIBO. Adv Med Sci 2015 Mar;60(1):118-124.

Erdogan A, Rao SS, Gulley D, Jacobs C, Lee YY, Badger C. Small intestinal bacterial overgrowth: duodenal aspiration vs glucose breath test. Neurogastroenterol Motil 2015 Apr;27(4):481-489.

Gabrielli M, D'Angelo G, Di Rienzo T, Scarpellini E, Ojetti V. Diagnosis of small intestinal bacterial overgrowth in the clinical practice. Eur Rev Med Pharmacol Sci 2013;17 Suppl 2:30-35.

Sachdev AH, Pimentel M. Gastrointestinal bacterial overgrowth: pathogenesis and clinical significance. Ther Adv Chronic Dis 2013 Sep;4(5):223-231.

Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M, Basilisco G, et al. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Aliment Pharmacol Ther 2009 Mar 30;29 Suppl 1:1-49.

Rana SV, Malik A. Hydrogen breath tests in gastrointestinal diseases. Indian J Clin Biochem 2014 Oct;29(4):398-405.

Braden B. Methods and functions: Breath tests. Best Pract Res Clin Gastroenterol 2009;23(3):337-352.

Ghoshal UC. How to interpret hydrogen breath tests. J Neurogastroenterol Motil 2011 Jul;17(3):312-317.

Vantrappen G, Janssens J, Hellemans J, Ghoos Y. The interdigestive motor complex of normal subjects and patients with bacterial overgrowth of the small intestine. J Clin Invest 1977 Jun;59(6):1158-1166.

Rana SV, Sharma S, Kaur J, Sinha SK, Singh K. Comparison of lactulose and glucose breath test for diagnosis of small intestinal bacterial overgrowth in patients with irritable bowel syndrome. Digestion 2012;85(3):243-247.

Malik BA, Xie YY, Wine E, Huynh HQ. Diagnosis and pharmacological management of small intestinal bacterial overgrowth in children with intestinal failure. Can J Gastroenterol 2011 Jan;25(1):41-45.

Lee JM, Lee KM, Chung YY, Lee YW, Kim DB, Sung HJ, et al. Clinical significance of the glucose breath test in patients with inflammatory bowel disease. J Gastroenterol Hepatol 2015 Jun;30(6):990-994.

Schatz RA, Zhang Q, Lodhia N, Shuster J, Toskes PP, Moshiree B. Predisposing factors for positive D-Xylose breath test for evaluation of small intestinal bacterial overgrowth: a retrospective study of 932 patients. World J Gastroenterol 2015 Apr 21;21(15):4574-4582.

Reddymasu SC, Sostarich S, McCallum RW. Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors? BMC Gastroenterol 2010 Feb 22;10:23-230X-10-23.

DOI: http://dx.doi.org/10.22037/ghfbb.v0i0.1113

Creative Commons License
GHFBB by Gastroenterology and Liver Diseases Research Institute is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


PISSN: 2008-2258

EISSN: 2008-4234


Privacy Policy | For Author | Online Submission | About | Contact

Copyright © 2016 Shahid Beheshti University of Medical Sciences. All rights reserved.