ArticleBMC gastroenterology2026
Extended hydrogen breath test analysis for optimized diagnosis of SIBO-positive IBS patients.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSmall intestinal bacterial overgrowth (SIBO) is suggested in irritable bowel syndrome (IBS). Optimal hydrogen levels and time frame for diagnosing SIBO are still under discussion. Our primary aim was to consolidate a discriminating threshold for a positive lactulose hydrogen breath test (LHBT) in IBS. As a secondary aim, we optimized the diagnostic time frame for the small bowel.
methodsLHBT was performed on 503 subjects who met the inclusion criteria. After excluding non-hydrogen producers, the remaining 462 subjects were 92 healthy individuals and 370 IBS patients. Peak hydrogen levels were summarized as median values with interquartile range.
resultsAt the 80-min orocecal cut-off, healthy subjects showed a peak hydrogen of 8(4–11) ppm compared with 10(4–29) ppm in the overall IBS group (p <0.0001). Using ≥20 ppm cut-off, sensitivity was 38% and specificity 77%. Peak hydrogen was highest in IBS-D (24(9-40) ppm; p <0.0001), intermediate in IBS-M (7(4-14) ppm), and lowest in IBS-C (7(4-10) ppm), showing sensitivities of 61%, 23%, and 10%, respectively, with specificity 77%.After antibiotics, IBS patients with low hydrogen were unchanged, whereas most with high hydrogen reduced their hydrogen levels (p <0.01).
conclusionUsing a cut-off level of ≥20 ppm during the first 80 minutes, LHBT can diagnose SIBO in people with IBS showing high breath hydrogen, as compared with those having low breath hydrogen. Hence, SIBO-positive patients can be separated from SIBO-negative IBS patients. To this end, a majority of SIBO-positive subjects respond to antibiotic treatment.
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