Run the List SIBO Part II: Diagnosis
Nov 24, 2025
Dr. Navin Kumar, a gastroenterologist and co-founder of a clinical education platform, teams up with guest-host Ally Scheve to unravel the complexities of diagnosing Small Intestinal Bacterial Overgrowth (SIBO). They dive into diagnostic tools, particularly focusing on the lactulose breath test and its procedure. Key insights include how to prepare for an accurate test, the significance of monitoring hydrogen and methane levels, and the impact of rapid transit on results. This conversation is packed with essential knowledge for those navigating digestive health.
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Breath Testing Is The Practical Standard
- Lactulose breath testing is the practical preferred diagnostic method for SIBO over endoscopic aspiration.
- It detects bacterial gas production noninvasively and is office-friendly.
Hydrogen And Methane Drive The Test
- The test measures hydrogen and methane produced when gut bacteria metabolize lactulose and these gases are exhaled.
- Measuring both gases matters because treatment differs by gas profile.
Clear Numerical Positivity Criteria
- North American consensus defines hydrogen positivity as a ≥20 ppm rise within 90 minutes and methane positivity as ≥10 ppm at any time.
- Tests can be hydrogen-only, methane-only, or mixed, which affects interpretation.