If you had a recent colonoscopy or barium enema procedure, wait four (4) weeks before using this test.
Do not use this test if you are taking any oral broad-spectrum antibiotics or bismuth preparations such as Pepto Bismol within four (4) weeks prior to administering the breath test.
Avoid laxatives, stool softeners or stool bulking agents one (1) week prior to the test including: Colace, Milk of Magnesia, Ex-Lax, Metamucil or Citrucel
All other prescription drugs, except oral antibiotics, may be taken prior to the test.
All vitamins and supplements may be taken prior to the test
24 hours prior to testing:
Avoid these foods: Beans, whole wheat pasta, all fruits, fiber or bran cereals, tofu, nuts, whole wheat and rye breads and high fiber foods (whole grains).
Examples of foods you can eat: Fish, chicken, eggs, white potatoes, white bread, white rice, regular pasta, dairy and well cooked vegetables.
Night Before test:
Stop Eating at least 8 hours before test. Patient may drink water
Day of Test:
DO NOT eat, chew gum or tobacco, smoke cigarettes before or during the test.
DO NOT sleep or exercise during the test.
DO TAKE prescription medications with a small amount of water prior to or after the test.
DO BRUSH your teeth prior to the test.
Collection Comments
There are two different types of test kits: 1. Lactulose 2. Glucose. The provider ordering the test must provide this information so we can distribute the correct test. You MUST label all tubes with patient's name, DOB, and MRN. Please refrain from placing any labels on outside of box. Please return all completed boxes to the IUHPL Sendout department.
Specimen Preparation
Collect one breath sample using the blue collection tube labeled Baseline.
Unscrew the cap of the breath collection tube and position the straw at the bottom of the tube. Tip: Keep the tube screw cap close by, ready to be screwed back on quickly!
Take a full breath and exhale through the straw directly into the tube for a count of 5. It is OK if some of your breath blows out of the top of the tube. This is normal.
After filling the tube with breath, replace the cap immediately. Screw cap so that it is “finger-tight". Do not over tighten cap. If you can't replace the cap on the tube within 5 seconds, simply start the breath collection again from step 1 aboveDissolve the glucose sugar in 8 ounces of water with vigorous stirring. There should be no visible crystals at the bottom of the glass.
Special Instructions for Testing Children
If the child weighs over 50 pounds, have the child drink the adult dose (8 ounces of the sugar solution).
For children weighing 35 to 49 pounds, pour ¾ of the sugar solution into a new glass. Add enough water to make 8 ounces of fluid. Administer 8 ounces of diluted sugar solution to child.
For children weighing less than 35 pounds, pour ½ of the sugar solution into a new glass. Add enough water to make 8 ounces of fluid. Administer 8 ounces of diluted sugar solution to child.
Drink the whole glass of solution. It is OK if this takes a few minutes. It will taste sweet. Note the time when you have finished drinking the glucose solution. This is the glucose dosing time.
Wait 30 minutes from the glucose dosing time. Collect one more breath sample using the pink collection tube labeled 30 min. Don't eat or drink anything.
Wait 60 minutes from the glucose dosing time (30 minutes from previous sample). Collect one more breath sample using the white collection tube labeled 60 min. Don't eat or drink.
Wait 90 minutes from the glucose dosing time (30 minutes from previous sample). Collect one more breath sample using the red collection tube labeled 90 min. Don't eat or drink until you finish this last breath collection.
Place all the tubes back in the slots in the original box along with the completed information sheet. Secure the box with the enclosed security seal.
Storage/Transport Temperature
Room temperature
Ordering Recommendations
The hydrogen breath test for small intestinal bacterial overgrowth is a non-invasive, low risk, accurate and fast tool to identify this serious condition. The aging of the population has increased the incidence of bacterial overgrowth. Atrophic gastritis, estimated to occur in 20 to 30% of the healthy elderly population, is the most common cause of reduced gastric acid secretion. This is a predisposing factor for bacterial overgrowth. The obesity epidemic has led to an outbreak of new diabetes mellituscases. SIBO occurs commonly in patients with diabetes mellitus, particularly those with gastroparesis. End-expiratory hydrogen and methane are measured by gas chromatography at baseline and periodically for 1 hour after 10 grams of lactulose are ingested. The diagnostic criteria for a positive SIBO result is a rise above baseline of 20 parts per million (hydrogen and methane) prior to the 60 minute breath collection.
Performed
Monday - Friday; Days
Methodology
GC
Reported
2 - 3 days
Performing Lab
Send Outs
Referral Lab
Metabolic Solutions
Synonyms
11790
Bacterial Overgrowth Brth-Lactulose
Bacterial Breath
BactBrth
Small Intestinal Bacterial Overgrowth
SIBO Breath
Hydrogen Breath
Bacterial Overgrowth w/ Lactulose
Reference Interval
Hydrogen gas – Greater than or equal to a 20 PPM increase over the baseline value for any of the post dose samples is interpreted as a positive result.
Methane gas - Greater than or equal to a 10 PPM increase over the baseline value for any of the post dose samples is interpreted as a positive result.
CPT Codes
91065
Test Code (Outreach Synonym)
11790
Catalog Code
9809449067
Collection
Collect
Expired Air in collection tubes
Preferred Draw Volume
1 mL
Unacceptable Conditions
Unlabeled tubes
Patient Preparation
Patient Prep
If you had a recent colonoscopy or barium enema procedure, wait four (4) weeks before using this test.
Do not use this test if you are taking any oral broad-spectrum antibiotics or bismuth preparations such as Pepto Bismol within four (4) weeks prior to administering the breath test.
Avoid laxatives, stool softeners or stool bulking agents one (1) week prior to the test including: Colace, Milk of Magnesia, Ex-Lax, Metamucil or Citrucel
All other prescription drugs, except oral antibiotics, may be taken prior to the test.
All vitamins and supplements may be taken prior to the test
24 hours prior to testing:
Avoid these foods: Beans, whole wheat pasta, all fruits, fiber or bran cereals, tofu, nuts, whole wheat and rye breads and high fiber foods (whole grains).
Examples of foods you can eat: Fish, chicken, eggs, white potatoes, white bread, white rice, regular pasta, dairy and well cooked vegetables.
Night Before test:
Stop Eating at least 8 hours before test. Patient may drink water
Day of Test:
DO NOT eat, chew gum or tobacco, smoke cigarettes before or during the test.
DO NOT sleep or exercise during the test.
DO TAKE prescription medications with a small amount of water prior to or after the test.
DO BRUSH your teeth prior to the test.
Collection Comments
There are two different types of test kits: 1. Lactulose 2. Glucose. The provider ordering the test must provide this information so we can distribute the correct test. You MUST label all tubes with patient's name, DOB, and MRN. Please refrain from placing any labels on outside of box. Please return all completed boxes to the IUHPL Sendout department.
Specimen Preparation
Collect one breath sample using the blue collection tube labeled Baseline.
Unscrew the cap of the breath collection tube and position the straw at the bottom of the tube. Tip: Keep the tube screw cap close by, ready to be screwed back on quickly!
Take a full breath and exhale through the straw directly into the tube for a count of 5. It is OK if some of your breath blows out of the top of the tube. This is normal.
After filling the tube with breath, replace the cap immediately. Screw cap so that it is “finger-tight". Do not over tighten cap. If you can't replace the cap on the tube within 5 seconds, simply start the breath collection again from step 1 aboveDissolve the glucose sugar in 8 ounces of water with vigorous stirring. There should be no visible crystals at the bottom of the glass.
Special Instructions for Testing Children
If the child weighs over 50 pounds, have the child drink the adult dose (8 ounces of the sugar solution).
For children weighing 35 to 49 pounds, pour ¾ of the sugar solution into a new glass. Add enough water to make 8 ounces of fluid. Administer 8 ounces of diluted sugar solution to child.
For children weighing less than 35 pounds, pour ½ of the sugar solution into a new glass. Add enough water to make 8 ounces of fluid. Administer 8 ounces of diluted sugar solution to child.
Drink the whole glass of solution. It is OK if this takes a few minutes. It will taste sweet. Note the time when you have finished drinking the glucose solution. This is the glucose dosing time.
Wait 30 minutes from the glucose dosing time. Collect one more breath sample using the pink collection tube labeled 30 min. Don't eat or drink anything.
Wait 60 minutes from the glucose dosing time (30 minutes from previous sample). Collect one more breath sample using the white collection tube labeled 60 min. Don't eat or drink.
Wait 90 minutes from the glucose dosing time (30 minutes from previous sample). Collect one more breath sample using the red collection tube labeled 90 min. Don't eat or drink until you finish this last breath collection.
Place all the tubes back in the slots in the original box along with the completed information sheet. Secure the box with the enclosed security seal.
Storage/Transport Temperature
Room temperature
Ordering
Ordering Recommendations
The hydrogen breath test for small intestinal bacterial overgrowth is a non-invasive, low risk, accurate and fast tool to identify this serious condition. The aging of the population has increased the incidence of bacterial overgrowth. Atrophic gastritis, estimated to occur in 20 to 30% of the healthy elderly population, is the most common cause of reduced gastric acid secretion. This is a predisposing factor for bacterial overgrowth. The obesity epidemic has led to an outbreak of new diabetes mellituscases. SIBO occurs commonly in patients with diabetes mellitus, particularly those with gastroparesis. End-expiratory hydrogen and methane are measured by gas chromatography at baseline and periodically for 1 hour after 10 grams of lactulose are ingested. The diagnostic criteria for a positive SIBO result is a rise above baseline of 20 parts per million (hydrogen and methane) prior to the 60 minute breath collection.
Performed
Monday - Friday; Days
Methodology
GC
Reported
2 - 3 days
Performing Lab
Send Outs
Referral Lab
Metabolic Solutions
Synonyms
11790
Bacterial Overgrowth Brth-Lactulose
Bacterial Breath
BactBrth
Small Intestinal Bacterial Overgrowth
SIBO Breath
Hydrogen Breath
Bacterial Overgrowth w/ Lactulose
Result Interpretation
Reference Interval
Hydrogen gas – Greater than or equal to a 20 PPM increase over the baseline value for any of the post dose samples is interpreted as a positive result.
Methane gas - Greater than or equal to a 10 PPM increase over the baseline value for any of the post dose samples is interpreted as a positive result.
