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New breath testing guidelines being developed for common gut disorder

Research 1 Aug 2017
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Gut health has become a hot topic in recent times. In particular, the millions of bacteria who call our gut home have become celebrities of their own microscopic world. Scientists has proven that if our gut bacteria are out of balance, our overall health and wellbeing can be affected.

One condition that can cause such an imbalance is small intestinal bacterial overgrowth (SIBO), a condition in which bacteria from others parts of the bowel migrate to the small intestine.

Diagnoses of SIBO is often difficult due to differing methods used within the medical community, but a recent consensus paper from a team of gut experts in the US may change that.

The paper, published in the American Journal of Gastroenterology, has provided the first-ever guidelines for the use of breath-testing in diagnosing SIBO. Titled Hydrogen and Methane-based Breath Testing in Gastrointestinal Disorders: The North American Consensus, it gives clarity on the best ways to test for SIBO.

What is SIBO?

SIBO is a condition in which the bacteria that are normally found in the large intestine migrate in large numbers to the small intestine, causing symptoms that mimic inflammatory bowel disease.

The small intestine is lined with small finger-like projections called micro villi, which absorb nutrients from food as it passes through. In people with SIBO, the gut bacteria feed on carbohydrates (sugars) and produce hydrogen as a by-product. The hydrogen is then absorbed into the bloodstream and expelled in the breath. As the human body doesn't naturally produce hydrogen, it is a positive confirmation of SIBO when detected in the breath test.

SIBO has been proposed as a cause for irritable bowel syndrome (IBS) in some patients – particularly in those with diarrhoea-dominant IBS – but there hasn't been a general clinical agreement on this.

Melbourne gastroenterologist, Associate Professor Henry Debinski, believes the US consensus is a positive step.

"Recently the focus on small intestinal bacterial overgrowth (SIBO) has evolved as a result of a growing recognition of its association with a range of common bowel symptoms including chronic diarrhoea, bloating, distension, the irritable bowel syndrome and complications of malabsorption,'' he says.

How is SIBO diagnosed?

The current method of SIBO diagnosis is small bowel aspiration, a medical procedure which involves passing an instrument (endoscope) via the mouth and stomach to the small intestine to obtain a fluid sample. A culture of the bacteria in the fluid is then created and tested in a lab.

The limitations of the procedure are that it is difficult to reach the small intestine to collect a sample, and there is also a risk of sample contamination by bacteria from the patient's mouth and oesophagus.

In comparison, the breath test is a non-invasive procedure that can be done a clinic waiting room, without surgery.

Associate Professor Debinski says that although the "gold standard" of testing for SIBO has been small bowel aspiration and culture testing, the method "has been cumbersome, limited by high cost, and lack of proper standardisation".

"Performance of breath tests has been viewed as a simple non-invasive solution which could potentially be widely available as a diagnostic modality for suspected SIBO," he says

This is good news for consumers and may offer guidance to laboratories or clinics keen to offer the breath test to their patients.

However, most new medical or scientific discoveries take time to trickle down from laboratory to medical practice. Gut health is such a new area of scientific discovery, we can expect developments to take time; in fact, the gut is referred to as the new "clinical frontier" by scientists who realise just how little we know about this part of the human body.

Associate Professor Debinski says the US consensus paper is "a long overdue document that addresses many of the disparities in testing".

"The meeting of experts with an expertise in both the science and clinical utility of testing provides an evidence-based approach that addresses basic statements relating to how hydrogen and methane-based breath testing should be performed," he says. "The consensus should be an initial blueprint for standardisation."

If you are worried or concerned about your gut health, contact your nearest gastroenterologist, or find the nearest clinic in your region. For a gut-friendly breakfast, try this new Banana, pepita and oat pancake recipe from the Jean Hailes Kitchen.