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Small Intestinal Bacterial Overgrowth Syndrome: A Guide for the Appropriate Use of Breath Testing

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Abstract

The increased availability of noninvasive breath tests, each with limitations, has led to widespread testing for small intestinal bacterial overgrowth (SIBO) in patients with non-specific gastrointestinal complaints. The lactulose breath test (LBT) is based upon an incorrect premise and therefore incorrect interpretations which has resulted in the over-diagnosis of SIBO and the excessive use of antibiotics in clinical practice. Despite limitations, the glucose breath test (GBT) should be exclusively employed when considering SIBO in appropriately chosen patients. This review suggests guidelines for the optimal use and appropriate interpretation of the GBT for suspected SIBO. The LBT should be discarded from future use, and the literature based upon the LBT should be discounted accordingly.

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  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 900 North 92nd Street, Milwaukee, WI, USA

    Benson T. Massey

  2. Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Madison, WI, 53705-2281, USA

    Arnold Wald

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Massey, B.T., Wald, A. Small Intestinal Bacterial Overgrowth Syndrome: A Guide for the Appropriate Use of Breath Testing. Dig Dis Sci 66, 338–347 (2021). https://doi.org/10.1007/s10620-020-06623-6

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