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Hydrogen & Methane Lactulose Breath Test
Rome IV Diagnostic Criteria
North American Consensus Guidelines

Small intestinal bacterial overgrowth (SIBO) is among the most common and most underdiagnosed explanations for chronic digestive symptoms. Breath testing is the non-invasive standard for detecting it, and the pattern of results matters as much as the numbers themselves.

Method
Lactulose breath challenge, clinical-grade device
Duration
2–3 hours in studio
Gases measured
Hydrogen (H₂) and Methane (CH₄)
Preparation
Low-fermentation diet prior, 12-hour fast

The small intestine is designed to be relatively sterile. When bacteria migrate upstream from the colon, the result is fermentation of carbohydrates before they can be properly absorbed. The gas produced is detectable in exhaled breath.

Hydrogen vs. methane, why the distinction matters
Pattern
Clinical Association
Hydrogen-dominant
Loose stools, diarrhea-predominant IBS, bloating, early satiety
Methane-dominant (IMO)
Constipation, slow transit, abdominal distension that doesn't resolve
Mixed pattern
Alternating bowel habits, bloating regardless of stool pattern

Methane production is classified as Intestinal Methanogen Overgrowth (IMO) under Rome IV guidance. The distinction from hydrogen-dominant SIBO matters clinically, they respond to different interventions and are managed differently.

If your symptoms follow specific foods rather than any meal, a targeted carbohydrate malabsorption panel for lactose, fructose, or sucrose may be a more precise starting point than a general SIBO test.

Commonly Ordered For

Patients with bloating, gas, abdominal discomfort, irregular bowel habits, or symptoms that worsen after eating, particularly carbohydrate-rich meals. Also indicated where a prior IBS diagnosis hasn't been explained by structural workup, or with a history of prior gut surgery, motility disorders, or prolonged antibiotic or PPI use.

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