If you have chronic intestinal discomfort, you might have small intestinal bacterial overgrowth (SIBO). This is a common ailment that, thankfully, is relatively easy to diagnose and treat. Despite that, it remains underdiagnosed because many people don’t know they should get tested. Here’s what you need to know about testing for SIBO.
How do I know if I need a SIBO test?
SIBO is a condition in which too many of certain types of bacteria colonize the small intestine. This can cause a variety of symptoms, including bloating, diarrhea, constipation, abdominal pain, and weight loss. If you experience these symptoms, consider talking to your doctor about a SIBO test or reaching out to a testing provider.
In addition, many people who have already been diagnosed with IBS, which is a chronic and complex ailment with similar symptoms, may actually have SIBO. Since SIBO is treatable and relatively easy to diagnose, it’s a good idea to follow up an IBS diagnosis with a SIBO test. There are two main tests doctors use, including a hydrogen/methane breath test and a small intestine aspirate test.
SIBO breath test
A hydrogen/methane breath test is a fairly simple and completely non-invasive way to get an accurate SIBO diagnosis. It measures hydrogen and methane gas levels in your breath after you consume some type of sugar solution. In the case of a SIBO test, the sugar solution will generally be glucose (sometimes lactulose), (whereas a lactose intolerance test would of course use a solution that contains lactose). The results help testing providers confirm or rule out certain specific causes of your digestive problems or accurately identify gastrointestinal disorders like SIBO.
The principle behind the hydrogen/methane breath test in lactose intolerance is that when the intestines don’t properly absorb certain sugars or carbohydrates, those sugars continue through the gastrointestinal tract and end up in the large intestine, or colon. Here, bacteria break down the sugars, producing gasses such as hydrogen and methane. These gasses are absorbed into the bloodstream and eventually exhaled. In SIBO the situation is different: the sugar gets metabolized early during the passage within the small intestine by the abnormal bacteria that colonize this area in such patients. This leads to an early rise in hydrogen and/or methane levels that is measurable in the exhaled air.
In a person with normal sugar digestion, there should be only a small increase in breath hydrogen levels after consuming a glucose solution. However, if a person has bacterial overgrowth, the undigested sugar may lead to a significant increase in the amount of hydrogen and/or methane in their breath, which the breath test can detect. So by measuring the concentration of hydrogen/methane in the breath samples over time, doctors or testing providers can assess how well the patient’s body is digesting and absorbing the sugar in question, aiding in the diagnosis of various gastrointestinal conditions.
You can do a SIBO breath test with the oversight of a doctor or testing lab, or you can purchase a home SIBO test and send your sample into our lab to get verified results. SIBO breath tests are easy to prepare for and non-invasive. The test requires patients to take nothing by mouth (NPO) for 12 hours, and the test itself takes around three hours to perform.
A normal result means that your body is digesting carbohydrates properly. An abnormal result means you may have SIBO, in which case you can discuss potential treatments or further testing options with your doctor.
Small intestine aspirate
A small intestine aspirate or jejunal aspirate is a test that involves passing a tube through the nose and into the small intestine to collect a sample of fluid. A doctor will culture the test to look for bacteria. This type of test can also help to diagnose SIBO and is considered even more accurate than a breath test. However, it is also more invasive and requires the oversight of a gastroenterologist. It is rarely used nowadays, but remains a second option if a breath test turns out to be inconclusive for whatever reason.
To perform a small intestine aspirate, the doctor will first insert a tube through the nose and into the stomach. The tube is then advanced into the small intestine. The tube suctions a small amount of fluid out of the intestine and collects it in a syringe. The doctor will then send the fluid to a laboratory to be cultured for bacteria.
A jejunal aspirate is a relatively safe but invasive procedure. Still, some individuals may experience pain, nausea, and vomiting. In rare cases, there may also be bleeding or an infection. If you are considering having a jejunal aspirate, discuss the risks and benefits of the procedure with your doctor.
The majority of doctors will recommend antibiotic therapy for bacterial overgrowth in the small intestine. Xifaxan is the most common antibiotic used for this purpose. Unfortunately, SIBO symptoms may return soon after the patient discontinues antibiotics, so you may have to alternate on and off antibiotics at regular or semi-regular intervals. Specific diets and supplements given after antibiotic therapy can help prevent recurrence. If your SIBO is a result of a structural irregularity in your intestine, you may need surgical correction.
And finally, a good SIBO treatment plan will include nutritional treatment. Whenever you have a gastrointestinal ailment, it’s possible that your poor digestion is causing malnutrition or a vitamin deficiency. So SIBO treatment may include B-12 injections as well as other vitamins and mineral supplements.
If you’re concerned that you might have SIBO, talk to your doctor about testing options or contact AllClear Healthcare to purchase a SIBO breath test so you can get certainty about your symptoms today.