How to diagnose SIBO - Small Intestine Bacterial Overgrowth?
The first step in the diagnosis of small intestinal malabsorption and irritable bowel syndrome is the SIBO test.
The SIBO test combines the detection of the two gases hydrogen and methane and thus allows to find out whether methane- and/or hydrogen-producing bacteria are the cause of the symptoms.
Furthermore, by assessing the time course of the breath gas test, a statement can be made about the position of the defective colonization in the small intestine.
This has very practical therapeutic consequences - depending on the site of colonization (upper or lower small intestine), a different diet is required; for methane-producing bacteria, for example, a different therapy regime applies.
The SIBO breath test is easy to perform and ideal as a home test. Sugar (synthetic or Glucose) is used as the test substance. Sugar cannot be digested and absorbed in the small intestine. Only intestinal bacteria are able to do this. Bacterial fermentation produces the gases hydrogen and methane, which are detected with the breath samples.
The SIBO breath test is the best breath test for detecting small bowel malabsorption and is based on international standards (2017 North American Breath Testing Consensus Guidelines).
After a first base test, a sugar liquid is drunk. A breath sample is obtained at 30 minute intervals. The sample tubes are sent to the laboratory for a detailed analysis.
This has very practical therapeutic consequences - depending on the site of colonization (upper or lower small intestine), a different diet is required; for methane-forming bacteria, for example, a different therapy regime applies.
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Healthcare professionals agree that the SIBO Breath Test is one of the best available options for testing for SIBO.
Intestinal flora - microbiome - biochemical stool diagnostics
Molecular genetic analysis of the intestinal flora is another important component of diagnostics. The analysis includes 14 functional bacterial groups, the FODMAP index and the detection of fungi.
In the intestine there are hydrogen producers the Bacteroidetes spp. as well as hydrogen consumers such as methane producing bacteria (which produce methane), sulfate reducing bacteria (which produce hydrogen sulfide - H2S), as well as acetate and propionate producing bacteria.
Biochemical stool diagnostics - e.g. GI Map Test
Examination of digestive performance with determination of digestive residues, bile acids and pancreatic elastase in stool (pancreatic function)
Examination of mucosal defense - secretory immunoglobulin A and EPX (eosinophilic protein X)
Examination of the inflammation marker calprotectin
Determination of short-chain fatty acids - butyrate, propionate and acetate
Detection of permeability disorders (leaky gut) using zonulin
Detection of bacterial metabolic activity - ß-glucuronidase
Detection of histamine in stool
bleeding and tumor marker hemoglobin