SIBO test

[Edgar77]

Can anyone tell me what a S.I.B.O test involves. I have suspected I may have this problem for some time.

[IBSNetwork Partner IBS Network]

Take a look at our website for correct information theibsnetwork.org/medical/s...

[b1b1b1]

I had a hospital based one and it is just a breath test. You breathe into a balloon about every 15 minutes over a 3 hour period, and the breaths are then analyzed for certain gases.

[Edgar77 in reply to b1b1b1]

I thought you had a special diet before hand or some awful meds that would give you the runs. Makes me wonder why they don't test all IBS sufferers.

[cj20uk in reply to Edgar77]

I did a home based one as it wasn't available on the NHS in my area. You do have to have a strict diet before taking it but there were no meds involved.

[b1b1b1]

I can't remember the details. There may have been a small drink right before the test, but definitely there was nothing difficult or awful, or a special diet. The main thing was boredom. You have to sit in a waiting room type room for 3 full hours and every 15 minutes a technician comes in with a balloon you breathe into. Don't worry at all; just bring a book as you will be bored.

[Luisa22]

I haven't done this test. I just read up about it. About the prep beforehand, I think you have to eat plain foods for a short time before the test. I'm not sure how long, it may just be a day or two before it. Things like plain chicken, fish, white rice, toast etc. Then there's a 12 hour fast overnight (which unless you get low blood sugar problems is pretty usual)

You drink a small amount of either glucose, or lactulose depending on how far into the small intestine you need results from. Lactulose gives you results from further down.

Then the breath testing begins.

It suppose it depends how you do with lactulose. Anyone with IBS C might benefit from it.

[TrexArms88]

Having done the test it really is nothing to worry about. I went to a private hospital and literally asked to (on two separate occasions) drink a lactose based drink and a glucose based drink.

You then report back every 15 or so minutes for a period of time (approx three hours). The changes in gases present can add evidence for or against SIBO. It's not fool proof though.

Dr Meghan Rossi did a paper about it recently, definitely look her up. She is a massive advocate of gut health and provides oodles of evidence based scientific/medical papers to refer her claims back to etc.

[LEENOL48]

Hi

I brought a test kit from healthpath all it says it follow a bland diet the day bedside testing and all you have to do is drink a solution and test your breath and regular intervals nothing to worry about

[xjrs]

SIBO Breath Test is the most common method used for diagnosis. It involves consuming a sugary drink and collecting samples of your breath at intervals up to 90 minutes. The samples are tested for hydrogen or methane. Hydrogen is produced by bacteria and methane by organisms called archaea in the large intestine and not the small intestine. Finding hydrogen and/or methane suggests misplaced bacteria and/or archaea in the small intestine. The cut off is 90 minutes since it can take up to 2 hours for the sugar solution to reach the large intestine. Hydrogen dominant SIBO tends to be associated with diarrhoea, whilst methane dominant is associated with constipation.

However, breath tests are not accurate since:

1. the sensitivity (accurately diagnosing those with SIBO) and specificity (accurately diagnosing those without SIBO) of the tests range from 44% to 83% indicating that the tests are not reliable

2. they can produce many false positive results, particularly in those who digest food faster than average

3. the tests can produce false negatives, often due to gastroparesis (slow emptying of the stomach)

4. lack of consensus on how to perform the tests

5. lack of agreement concerning what amount of gas should determine a positive diagnosis

I was diagnosed with both hydrogen and methane SIBO, but didn't respond to any of the treatments and in fact, my health became far worse as a result of the treatments. My final diagnosis through the NHS was entirely different. So it is a tough one. If you go down this route ensure it is with a medical professional (GP/gastro) and not any of the functional medicine/nutritional therapy practitioners which are not recognised by the NHS - they made me severely ill and there has been a whole industry generated around this from which they are making vast sums of money without necessarily helping.

Note that you won't have SIBO unless you have one of the causes and if you have one of the causes, this will need treating first, otherwise treating SIBO on its own would be futile since it would keep coming back. You could work through the cause list with a medical professional, which is:

Stasis: dysmotility – problems with muscle contraction in the gastrointestinal tract

Surgery (loops, vagotomy, bariatric)

Short Bowel Syndrome

Stuck open ileocecal valve (which sits between the small and large intestine) allowing bacteria from the large intestine to flow back into the small intestine

Achlorhydria – no stomach acid – unlikely if you can experience acid reflux. Additionally a faecal elastase test would show if you aren’t breaking down proteins correctly (which require stomach acid for digestion)

Hypochlohydria – low stomach acid – see above – the only real test is a PH test directly into your stomach, but many practices do not carry this out and home testing is inaccurate

PPIs – proton pump inhibitors for GERD/acid reflux – this is particularly related to long term use

Malnutrition – excess bacteria in the small intestine can compete for nutrients that your body needs

Collagen vascular disease – immune system inflammation e.g. arthritis

Immune deficiency

Advancing Age

Chronic Pancreatitis – this causes constant abdominal pain/fatty stools

Chronic antibiotic use

IgA Deficiency – identified from GP blood tests

Coeliac Disease – identified from GP blood tests

Crohn’s Disease – identified through GP tests and colonoscopy if GP tests indicate referral is needed

NASH – non alcoholic fatty liver disease –identified from GP blood tests

Cirrhosis

Fibromyalgia – widespread pain

Rosacea

The first 4 in the list above should be identifiable via a small bowel MRI scan.

[Wonderwall3 in reply to xjrs]

I have severe Fibromyalgia/allodynia/ chronic constipation dominant IBS/acid reflux/osteoporosis. I suspect I've got nerve damage in my GI tract because I don't typically empty my bowels for up to 14 days at a time, even with dulcolax, it's at least a week. When I do eventually go to the loo, the pain afterwards is absolutely excruciating. I had a colonoscopy last September due to a high FIT test result. Thankfully, it was clear but the technician said that my large intestine was 'long and floppy'. It's pretty evident I'm likely to have SIBO with all these comorbidities. I've lost over 2 1/2 stone in the last 2 years because of being unable to eat because of pain and I cannot afford to lose that amount of weight. I have had a couple of consults with an NHS dietician who would like me to try the low FODMAP diet but because my diet is so restricted already, I am reluctant to do this at the moment and I'm still losing weight. My Gastro consultant has never seen me face to face, despite my requests. Do people think that I should push to have that test done or would it be pointless unless I get treatment for everything else (very longwinded/difficult on the NHS)?

[xjrs in reply to Wonderwall3]

In my lay person's opinion, since you are suffering from chronic constipation, it is unlikely to be hydrogen SIBO, since this tends to be related to diarrhoea. There is a tiny chance of methane SIBO, which is constipation related, but in your shoes that wouldn't be my first port of call.

In your case, what needs working on urgently is the constipation and the pain. Firstly, what is your fibre intake like? If you need help with diet needed for chronic constipation, I have some information which I can post here, if you want? I suffer from IBS-C with a long loopy colon and visceral hypersensitivity (pain). Linaclotide (available on prescription for IBS-C and pain) and Alflorex probiotic, plus a high fibre diet have helped me greatly with this.

In terms of the low FODMAP diet, it could make your constipation worse, since it reduces feed for the microbiome and much of stool is made up of bacteria. Some people's IBS pain is due to a gut bacterial imbalance with a dominant bad bug over sensitising intestinal nerves. Additionally if you are having to restrict your diet so much, this also reduces feed for the microbiome, which can lead to more food intolerances, as things become even more out of balance, so it is a vicious circle. I am assuming that you are finding fibre difficult to tolerate due to the pain. Alflorex has made me more tolerant to a wider variety of foods, including fibre. Linaclotide helps calm intestinal nerves as well as increasing motility, though for me it just helped with the pain, my diet does the rest.

[Edgar77 in reply to xjrs]

I see where your coming from, I was diagnosed with BAM after the 2 scan s despite IBSC so can't take the usual meds for it. I take more fibre than I used to. As a celiac I have the high fibre bread. Porridge every day and a banana at least 2 veg with dinner ect ect I know the diet is ot varied enough but I'm working on it. I found the fodmap diet easy as I was already gluten free and there are so many alternatives to lactose. I find some fodmaps ican tolerate and so.e not. So it is trial and error. Sometimes it just doesn't make sense. IBS is one of many symptoms of fibromyalgia.

[Wonderwall3 in reply to xjrs]

My fibre intake is pretty high already. I only eat wholemeal/granary - seeded bread, have porridge or muesli for breakfast, eat alot of wholegrain rice and pasta, plus steamed vegetables. I also have tinned prunes and soya yoghurts for dessert. My dietician told me to up my calories so I've been encouraged to have ice cream, rice pudding and snack in between meals. My daughter thinks I might be having too much fibre for my system to cope with. I would appreciate any information you can give please. Visceral hypersensitivity is off the charts, Fibromyalgia amplifies the pain and when I've got pain in my gut (99% of the time) the pain is everywhere, from my face downwards! I'm trying to make my diet more varied but I'm at the stage where I'm pre-empting the pain. I had a sweet potato katsu curry and steamed veg on Thursday evening but literally an hour later, had horrendous heartburn, then that kicked off the rest of my gut. Last night I has a mushroom slice with steamed veg and this morning, my stomach is on fire and the burning has spread all around my neck! Even my legs are now burning! It's absolutely awful. I did try a month on linaclotide but I felt it didn't do much. The next consult I had with my Gastro consultant was last February and he prescribed a month of prucalapride, which I thought helped a bit, but it's a drug which can only be prescribed from hospital and of course I finished the course but then could not speak to the consultant to get another month so I was without it for four months. I am due to speak to him again, but not until the end of August so going to try and get it on repeat so it can be prescribed by my GP.

I heard about biokult probiotic so am going to give that a go but at this point, I'm not hopeful that there will be much improvement in my pain levels. They seem to be getting worse and more widespread.

[xjrs in reply to Wonderwall3]

The full pain effects of Linaclotide are not reached until the 10 week mark. However, the widespread pain of fibro is probably complicating things. I would have thought prucalapride could be prescribed by the GP. I got Linaclotide from the gastro and then had it on repeat at the GP surgery. I am not an expert on fibro and I wish that the scientific community were further forward on all of these illnesses. I can post my constipation advice below, though not sure if it will be of much help. I needed the Alflorex to make me more tolerant to the fibre. It has been the probiotic that has helped me the most and I have tried others. It contains Bifdobacterium which helps to digest complex carbs, as well as kicking any bad bugs into touch and rebalance things. The bacterial imbalance can cause pain and food intolerances.

Re constipation:

To improve constipation in the short term you can try ground flaxseed on your breakfast, starting at 1 teaspoon and increasing at 1 teaspoon every 2-3 days - you'll need to consume extra water with it.

These foods are also high fibre:

8-9 Prunes - you already have these

2 tablespoon chia seeds (soaked for 10-15 mins in milk or non dairy milk with cereal or water)

Shredded wheat (or if GF: Nutribrex)

60g Quinoa

Wholewheat bread

75g Whole grain pastas (if GF: Buckwheat)

2 Hard pears

5 Dried apricots

90g Raspberries

1 orange (contain a natural laxative)

2 kiwi.

I find that I need to have 1 orange or 2 kiwi a day and then another high fibre fruit later in the day to help with BMs. Introduce new foods and any fibre increases slowly, starting with one new thing at a time, waiting for 2-3 days for a response and keep a food diary. You may not need to consume as much fibre as I do.

For breakfast I make a porridge of 4 tablespoon of oat bran and 4 tablespoon all bran (wheat bran), 2.5 small cups of water and microwave for 10 mins. I then mix in 2 tablespoon of chia seeds and 1 tablespoon ground flaxseed and leave to stand for 15-20 mins since the chia seeds need to form a gel. On top of that I place 8 prunes and eat. The best thing to do is to start with normal oats in similar quantities and, if needed, replace one of the tablespoons of oats with oat bran for a couple of days, carrying on doing this every couple of days until you get to 4 tablespoon of oat bran and 4 tablespoon of oats. Then start replacing with wheat bran in the same manner. You can then add the other ingredients one at a time. You might find you do not need the complete 'recipe' to have a BM. All these individual components are down to tolerance, so it is best to keep a food diary (I do this on a spreadsheet) recording symptoms for up to 2-3 days after each change.

I also take 30 drops of ginger extract before bedtime to aid motility. You may need to work up the dose to say 7 drop increments each night.

Exercise can help with BMs. The government recommends 150 mins of moderate exercise (e.g. walking as if you are late for an appointment) or 75 of intense exercise (e.g. jogging) per week. I also have a bit of a walk around straight after breakfast to get things moving.

You need to ensure that you are drinking enough fluids (2 litres of fluid per day).

There is some good advice about constipation here:

theibsnetwork.org/constipat...

theibsnetwork.org/constipat...

Failing dietary measures, you can try Optifibre, which needs to be worked up to a dose according to instructions. You may not need the full dose - watch out for gas and increment to a level that is acceptable for you.

I have also found useful having most of my food at meal times, leaving 4-5 hours of not eating between meals, eating my fruit snack before a meal. This means that your digestive system has time to process each meal. It also allows something called the MMC (migrating motor complex) to run which sweeps food waste from your small intestine into your large intestine. This only happens when you have an empty stomach. When people snack regularly, it prevents the MMC from working properly. I also find the larger meals help to push things along better than drip feeding through snacking.

[Luisa22 in reply to xjrs]

Brilliant post, xjrs. Thanks.

I have been nagging my brains as to whether or not I could have SIBO, even though I don't actually have most of the SIBO symptoms.

I did one of those SIBO quizzes on a very nice looking "doctor-style" website. I scored 4 out of 17. The reply was that I "very likely did have SIBO".

Er....yeah right....duhhh! Because I also noticed they were selling their own wonder mix supplement for SIBO . Haha...I must have been half asleep filling that in. Most of those sites have strong vested interests.

At the least it's just a way of harvesting your email to send you umpteen newsletters and special offers on expensive tablets.

So, seeing as I score absolute zero on the list that you quoted for causes, I'll just carry on with dratted regular IBS

[xjrs in reply to Luisa22]

Yes, it can be quite annoying how some are trying to capitalise on other people's ill health. It's a shame that you have to be on the look out and protect yourself from it.

I bet you, on that website, even if you had a score of 1 out of 17, they would say that you have SIBO, just to get their mitts on you as if you are their ATM :-).

This is with the knowledge that:

a) you can't diagnose SIBO from symptoms

b) there aren't accurate tests

They are trying to give people false hope and empty their pockets in the process.

[Luisa22 in reply to xjrs]

I find what you said interesting and also a bit worrying: "a) you can't diagnose SIBO from symptoms"

Ooops....so I or anyone else could still have it but the symptoms are indistiguishable from other problems? Plus there's no reliable testing for it. That's disappointing.

[xjrs in reply to Luisa22]

An approach might be, if SIBO is suspected, to first check whether you have any of the causes. Then do a breath test, which may or may not be accurate. If positive, then a trial of medication (Rifaximin) - though really the cause needs tackling first. If medication does nothing, then potentially it isn't SIBO. Another indicator might be if taking probiotics progressively makes symptoms worse.