How is the breath test performed?
The patient takes in air and blows into a special pouch, and then inserts a glass vial into the mouthpiece. He then consumes 10 grams of lactulose solution, which, as a synthetic disaccharide consisting of galactose and fructose, is not absorbed in the small intestine and is fermented by intestinal bacteria. Lactulose moves down the digestive tract, while bacteria break it down into short-chain fatty acids, hydrogen and carbon dioxide. Hydrogen is dissolved in the blood and is transported to the lungs, where we can test for its presence in exhaled air. The hydrogen can be used by the archeons to produce methane. The patient repeats the exhaled air procedure every 20 minutes over the course of 3 hours. If there is an elevated increase in hydrogen and/or methane in the relevant section of the small intestine, this may indicate bacterial overgrowth in the small intestine SIBO or IMO archeons. The vials are sent to an outpatient clinic, whose staff tests the samples for hydrogen and methane using a Qunintron instrument. The patient receives the result of the test via email within two business days of receiving the samples.
What are the indications for breath testing?
Indications for the test may include excessive bloating, gas, abdominal pain, diarrhea, loose stools, constipation, reflux, heartburn, bad breath, a feeling of overflow, fullness in the epigastrium, headaches and anemia. Symptoms can worsen especially after eating foods such as onions, garlic, leek, cauliflower and apple. After a prolonged period of illness, symptoms may worsen after just drinking a glass of water on an empty stomach.
What are the contraindications to breath tests?
Absolute contraindications are hereditary fructose intolerance and postprandial or reactive hypoglycemia.
Is a referral needed for the test?
The test does not require a referral from a doctor.
What is the preparation for the test?
Read carefully the procedure for preparing for the test. This is very important, as improper preparation may disturb the result and you will have to repeat the test at another time.
On the day of the test:
– get up about an hour before the test
– be fasting
– drink a glass of pure non-carbonated water, which helps perstantiation
– brush your teeth with toothpaste without xylitol
– you can use an antiseptic mouthwash
– if you wear dentures do not use denture glue
– do not do any physical exercise
– sit in one place, do not lie down, do not sleep
– don’t chew gum or eat any foods
– do not take any medications, you can take medications after the test is performed
14 hours before the test:
– do not take any food, except pure non-carbonated water
– do not smoke cigarettes
– do not chew gum
1-3 days before the test:
– if you have diarrhea or normal stools, follow the diet 1-1.5 days
– if you have constipation follow the diet 2-3 days
– you can only eat non-fermentable foods such as:
1) meat, fish, seafood, eggs
2) non-carbonated water
3) rice in small quantities
4) fats (oil, oil, lactose-free butter)
5) spices only pepper, salt
– do not consume fermentable products such as:
1) grain products (bread, rolls, pasta, groats)
2) dairy products and milk with lactose
5) fruit juices and fruit products
6) nuts, seeds
3 days before the test:
– do not consume stomach drops, betaine HCl, apple cider vinegar
– do not take laxatives such as lactulose
– do not take digestive enzymes
– do not take supplements with fructose
One week before the test:
– do not take probiotics and prebiotics
– antibacterial herbs (e.g. oil of oregano)
– in consultation with your doctor, avoid proton pump inhibitors PPIs and H2-receptor antagonists (e.g., polprazole, omeoproazole)
– do not take large doses of magnesium and vitamin C
One month before the test:
– do not use antibiotics (furazolidone, nifuroxazide, bismuth preparations, xifaxan)
– do not undergo colonoscopy, fluoroscopy
What might be a sample menu 1-3 days before the test?
Breakfast: scrambled eggs with ham only in butter without vegetables or bread
Lunch: Grilled chicken with some basmati or jasmine rice
Dinner: steamed fish
During the day you can sip pure non-carbonated water, weak tea and coffee without sugar and milk