Small Intestinal Bacterial Overgrowth (SIBO) 3 Hour

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Turnaround Time: 7-10 Days
CPT Code:
  • 91065 Hydrogen
  • 91065 Methane
Test Type: Kit-Based, Breath Test


SIBO Profiles are non-invasive breath tests which capture exhaled hydrogen (H2) and methane (CH4) gases following patient ingestion of a lactulose solution to evaluate bacterial overgrowth of the
small intestine.

Clinicians have the option of a 2 or 3-hour SIBO assessment.
The 3-hour SIBO profile provides insight into gas levels over a longer period of time, and is recommended for patients with slower gastrointestinal transit or constipation.

When should testing for SIBO be considered?

Symptoms of SIBO are non-specific, encompassing abdominal pain/distention, diarrhea, and flatulence.

Conditions commonly associated with SIBO include:

  • IBS
  • IBD
  • Celiac Disease
  • Diabetes
  • Fibromyalgia
  • Rosacea
  • Parkinson's Disease
  • Obesity

Risk factors for development of SIBO include structural/anatomic issues, motility disorders, organ system dysfunction, elderly age and various medications (recurrent antibiotics, PPIs) that alter the gut microflora populations.

Symptomatic patients with any underlying conditions or risk factors warrant assessment for SIBO.

What advantage does the SIBO breath test offer compared to other diagnostics?

While aspiration of small bowel fluid (followed by culture and bacterial count) is considered to be the current gold standard for diagnosis of SIBO, it is not routinely performed because it requires a complex, invasive technique, and is costly. As a result, experts suggest breath testing for the diagnosis of small intestinal bacterial overgrowth.

What can clinicians and patients expect from the SIBO breath testing?
In general, clinical management of the SIBO patient involves antimicrobial therapy, prokinetic agents, nutrient supplementation, dietary interventions, and treatment of comorbid conditions.

Genova's SIBO profiles reflect the current state of scientific understanding related to SIBO breath testing and results interpretation – and are designed to optimize management of the symptomatic patient.

Performing Lab: Genova

Collection Details:

Patient Preparation:



  • Wait 4 weeks from your last dose of antibiotics, colonoscopy or barium enema.
  • Wait at least 2-4 weeks from your last dose of antifungals, Pepto-Bismol™ or herbal/natural antimicrobial products.


  • Avoid the use of laxatives, stool  softeners, and/or stool bulking agents as well as antacids containing aluminum or magnesium hydroxide.


  • Foods you CAN eat before you start your 12 hour fast:
    Baked or broiled chicken, fish or turkey (salt and pepper only), white bread (only), plain steamed white rice, eggs, clear chicken or beef broth with no vegetable pieces, water, plain coffee, or tea (no sugar/ artificial sweeteners or cream). 
  • Vegetarians may have tofu with salt and pepper.
  • Do not take probiotics.


  • Fast for 12 hours prior to the test. Do not eat or drink anything other than water for 12 hours prior and during the test. 
  • Do not take non-essential medications or supplements until the test is completed, unless your physician has advised you otherwise. Do not chew gum, eat candy, or use mouthwash until the test is completed.


  • No smoking, including second-hand smoke, for at least 1 hour before or at any time during the breath test. 
  • No sleeping or vigorous exercise for at least 1 hour before or at any time during the breath test.
  • Do Not Use Toothpaste.

Special Instructions for patients weighing 100 pounds or less:
Follow the instructions on the blue bag for rolling and stapling the bag in accordance with weight. (Note: stapling will not damage the bag or affect the results).

Important Things to Know and Consider:

This test uses lactulose; since lactulose contains galactose and lactose, it is not recommended for individuals who have had allergic reactions to lactulose, or who are on a galactose/ lactose restricted diet. It should be used with caution in diabetics.

Do not open, remove, or loosen tops of collection tubes–this will break the vacuum and make it impossible to perform your test. Do not stick your finger into the mouthpiece/plastic bag – there is a sharp needle inside.

We do not suggest collecting during an acute infectious illness. This collection is extremely time-sensitive. You need to carefully plan the morning around these timed collections. An uninterrupted 2 or 3 hours is ideal.

Use the Breath Collection Schedule Table on the front of the Requisition to help you schedule your collection times. Be sure you fill in the Table as the test progresses.


Specimen Requirements

SIBO 2 Hr - Six fasting breath samples, taken at Baseline, 20 minutes, 40 minutes, 60 minutes, 90 minutes, and 120 minutes

SIBO 3 Hr - Eight fasting breath samples, taken at Baseline, 20 minutes, 40 minutes, 60 minutes, 90 minutes, 120 minutes, 150 minutes, and 180 minutes

Collection Instructions:

To ensure accurate test results you must provide the requested information.

1. Write patient’s first/last name and the tube number (1 - 6 (or 8) in order of collection) on
the tube labels provided. Write patient’s first/last name, date of birth, gender and date of collection on the Test Requisition Form.

2. Stir the Lactulose solution into 8 ounces of water. Set aside until after you have completed
your first breath collection. Brush your teeth and tongue (including the back of your tongue) without using toothpaste or mouthwash. Rinse your mouth with water.

3. Take the first collection tube and apply the label to the tube.
Be sure to record the time and date of collection to the label and the collection time on the Breath Collection Table (located on the requisition).

4. Pick up the mouthpiece/plastic bag in one hand and Tube 1 in your other hand.

5. Breathing normally, inhale and hold for 5 seconds. Then close your mouth tightly around the mouthpiece and exhale normally into the plastic bag until it fills completely. Do not blow hard.

6. Continue to exhale normally with the bag expanded, and press the specimen tube into the side part of the mouthpiece. The needle will puncture the tube’s self-sealing membrane allowing air to fill the tube. Do not inhale at any point.

7. Remove the tube within 2 seconds of puncturing. You may stop exhaling into the mouthpiece. Do not unscrew the cap on the collection tube. Place the tube in the bubblewrap bag.

8. Immediately drink the Lactulose solution before continuing with the rest of the breath test. Drink the entire amount within 5 minutes. Do not drink water for 1 hour after you drink the solution.

9. Repeat steps 3-7 for each breath collection, using the remaining tubes and labels 2-6, in order and according to the collection schedule. Record times on Collection Schedule found on the Test

10. If doing the 3 hour collection, repeat steps 3-7 for each breath collection, using the remaining tubes and labes 7-8 in order and according to the collection schedule.