Breath Testing Protocol for Gastrointestinal Disorders

Standardized Protocol for Hydrogen and Methane Breath Testing

Gastroenterology

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Last updated: Mar 24, 2025

Overview

Breath testing is a non-invasive diagnostic tool used to detect various gastrointestinal conditions, including small intestinal bacterial overgrowth (SIBO), carbohydrate malabsorption, and H. pylori infection.

Pre-Test Requirements

Patient Preparation (24-48 hours before)

  • No antibiotics for 4 weeks prior
  • No probiotics for 2 weeks prior
  • No colonoscopy or barium studies for 4 weeks prior

12 Hours Before Test

  • Stop eating and drinking (except water)
  • No smoking or vigorous exercise
  • Avoid sleep medications

Equipment Requirements

  • Breath testing device (validated for H2/CH4)
  • Collection tubes/bags
  • Substrate solution (lactulose, glucose, or fructose)
  • Timer
  • Recording forms

Testing Procedure

1. Baseline Collection

  1. Verify patient compliance with preparation instructions
  2. Collect baseline breath sample
  3. Record baseline H2 and CH4 levels

2. Substrate Administration

  • Lactulose solution: 10g in 200mL water
  • Glucose solution: 75g in 200mL water
  • Fructose solution: 25g in 200mL water

3. Sample Collection

  • Collect samples every 20 minutes
  • Continue for 2-3 hours
  • Record values on standardized form

Result Interpretation

Positive Results

  • H2 rise >20 ppm over baseline
  • CH4 rise >10 ppm over baseline
  • Combined H2/CH4 rise >15 ppm

Documentation Requirements

  • Patient demographics
  • Test type and substrate used
  • Time-based readings
  • Symptoms during test
  • Final interpretation

Quality Control

  • Calibrate equipment daily
  • Maintain temperature control
  • Document lot numbers
  • Regular staff training

Safety Considerations

  • Monitor for adverse reactions
  • Emergency protocols in place
  • Proper ventilation
  • PPE as needed

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