Small intestine bacterial overgrowth tests

For symptoms such as diarrhoea, nausea, bloating, gas and abdominal cramps, this test detects abnormal growth of bacteria in the small intestine.

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What is a SIBO breath test?

Hydrogen and methane breath testing is a widely accepted means of identifying changes to the gut microbiome and is used to detect abnormal growth of bacteria in the small intestine, or small intestinal bacterial overgrowth (SIBO).


You may be referred for this test if you are experiencing symptoms including diarrhoea, nausea, bloating, gas and abdominal cramps.

How it works

You will provide an initial breath sample by blowing into a test tube through a straw, or into a breath collection bag, which will give us your baseline reading.

You will drink water with glucose or lactulose within 1–2 minutes. Breath samples will be taken every 15 minutes for just over two hours to measure hydrogen and methane.

During the test, you should take note of any symptoms you experience and complete the symptom form, which will then be interpreted alongside the data collected by a clinician.

Download the information leaflet

Preparing for your test

Before you test, there are some things we ask you to do, to ensure safety and accurate results. This includes stopping certain medication and fasting for a short period.

Please read our patient information leaflet for full details.

4 weeks before your test

Do not take any antibiotics.

1 week before your test

Do not take laxatives or stool softeners  (Movicol, Dulcolax, Ex-Lax, Senna,  Milk of Magnesia etc.)

Do not take stool bulking agents (Metamucil, citrucel etc.)

Do not take motility agents 

(Prucalopride, linaclotide etc.)

Do not take probiotics   

(VSL#3, Actimel, Yakult etc.)

You can continue taking any other essential  medicines. Additionally, there must be a period of one week between any tests which require cleansing of the bowel e.g. colonoscopy, barium enema, before having a breath test.

2 days before your test

No anti-diarrhoeal medication (e.g. Loperamide (Imodium))

The day before your test

You must follow the ‘white food diet’ which  consists of only the following foods and drinks:    

• Plain white bread

•  Plain white rice

•  White potatoes (no skin)

•  Baked/grilled chicken, turkey, lean beef,  lean pork, white fish (no oily fish)

•  Maximum of 2 eggs

•  Water (non-carbonated)

•  Non-flavoured black coffee (no milk)

•  Non-flavoured black tea (no milk and no  herbal teas)

•  1 tbsp butter/margarine/oil

•  Salt to flavour food  

Do not eat or drink anything else, eating  prohibited foods could give false results for the test.

For 12 hours before your test

You must stop eating and drinking and fast for 12 hours before your test.

The day of your test

  • You can have small sips of water (maximum of 300ml) until the start of your test

  • You may take your essential medicines with a small amount of water

  • You may brush your teeth

Do not eat, drink, chew gum, smoke, eat breath  mints and/or other sweets on the morning of or during of your test.

ⓘ If you are diabetic requiring insulin or diabetes medicine, please ask your doctor if you should change your morning dose. Oral hypoglycaemic medicines are usually not taken that morning until completion of the test and you start eating again.

Getting your test results

The results will be displayed as a line graph that can be analysed by our clinical team to see if you've got small intestinal bacterial overgrowth.

Following your test, your data will be analysed and results written up into a report.

The report will be sent to both you and your referring consultant/doctor, who will explain the results to you in a follow-up consultation.

Paying for your test

Self-paying: If you are paying for this test yourself and not through insurance, the cost will be £250.

This cost includes cost of the postal kit, analysis and the report.

Insurance coverage

If you have private medical insurance, most companies can cover this for you.

After the Test (Post-Procedure Care)

After 24 hours, you can restart any medication and continue your everyday activities as usual.

Your results will be sent to a specialist for investigation, and you will get your detailed results at your next appointment with your consultant, who will discuss the outcome and all treatment solutions.

Frequently Asked Questions

Do I need to stop any medications prior to the test?

Yes. The test should be taken at least 4 weeks after antibiotics. If you take a long-term, low dose antibiotic then you may continue. Laxatives and promotility drugs should be stopped from 1 week before.

If you struggle to use the toilet without them, osmotic laxatives, such as Laxido or Movicol can be stopped from 2 days before. Probiotic supplements should be stopped for 1 week before. Fermented foods like kefir and yoghurt are ok to continue.

Anti-diarrhoeal medications, such as Imodium, should be stopped from 2 days before.

Do I need to fast before the test?

Yes. You need to fast for at least 12 hours before the test. You should also follow a strict low-fermentable diet on the day before the test.

What foods can I eat on the day before the test?

  • pain white bread

  • plain white rice

  • plain white potatoes (no skin)

  • baked or grilled white meat or fish (no oily fish, no skin)

  • firm or extra firm tofu

  • eggs (maximum of two)

  • water

  • non-flavoured black coffee or black tea (no milk)

  • only salt may be used to flavour your food

  • a little butter, oil or margarine is permitted (1tbsp)

No other foods or drinks are allowed.

What happens if I vomit during the test?

If the event was within 15-30 minutes after consuming the substrate, the test needs to be repeated.

If the event was more than 30 minutes after consuming the substrate, the test can be continued as

normal.

What is the difference between glucose and lactulose?

Glucose is absorbed in the 1/3 rd of the small intestine so it will not be able to detect SIBO that is further along in the small intestine. However, because of this, glucose is more sensitive than lactulose, so you can be more confident that it is SIBO when a test is positive.

Lactulose is not absorbed by the digestive tract and will travel through the entire small intestine and then to the large intestine (colon). This means that lactulose can be fermented by bacteria in the colon, so some tests can be false positive. That being said, a positive lactulose breath test has been shown to predict response to treatment i.e. if you test positive, then you are much more likely to improve with antibiotics.

How long are the samples valid for?

The breath samples are stable for at least two weeks and across a wide temperature range (-20°C to 40°C). Samples received after two weeks of collection may be invalid.

Can I take more than one test on the same day? For example, lactose and fructose.

No. Each test must be taken after fasting for 12 hours and following a subsequent 12-hour pre-study diet.

Taking two tests on the same day will produce invalid results.

How long until I get the results?

Once the kit arrives back to our lab the results will typically be available within 3 working days.

How is the test analysed?

The test is analysed by a state-of-the-art gas chromatography system, which measures hydrogen, methane, and carbon dioxide levels in line with recommendations by the UK and North American Consensus on Hydrogen and Methane-based Breath Testing.

Will the results be sent securely to my doctor?

Yes. All results are sent encrypted and password protected to the doctor or healthcare professional who referred you.