Diagnosis
in the breath. If there are too many bacteria in the small intestine of a patient with SIBO, this leads to an elevated level of hydrogen and methane being detected in the breath, which can support clinicians in providing the correct treatment for this condition. These tests are known as Hydrogen Methane Breath Tests (HMBTs) and can be completed either in the clinic or at home. Several NHS Trusts have embraced breath analysis as part of their diagnostic technology, recognising its potential to streamline the diagnostic process and improve patient outcomes. By integrating breath analysis into clinical practice, healthcare providers can now diagnose conditions such as SIBO and carbohydrate malabsorption quickly and efficiently, therefore reducing the burden on patients and healthcare resources. Many of the issues seen in SIBO are also seen in the development of IBS, hinting at a possible link between the two conditions. Studies have found that patients with IBS tend to have higher bacterial counts in the upper small intestine compared to healthy individuals, which is the main cause of SIBO. Additionally, IBS patients are more likely to exhibit abnormal results in HMBTs, with anywhere between 4% and 78% of IBS patients potentially also having SIBO.7
Although
this frequency is varied, SIBO is found to be more common among IBS patients than healthy controls, suggesting a significant relationship between the two diseases. This also highlights how underdiagnosed SIBO may be and could be the underlying factor of symptoms in other gut conditions.
Future potential of breath tests Exhaled breath analysis holds immense promise for transforming the way individuals monitor and manage their gut health. As well as hydrogen and methane, exhaled breath also contains a wide range of volatile organic compounds (VOCs), which are gaseous molecules that originate from within the body (endogenous VOCs) or from external sources such as diet, prescription drugs, and environmental exposure (exogenous VOCs). VOCs can provide a rich source of information
regarding overall health and have the potential to act as biomarkers of disease onset and progression. Endogenous VOCs can be produced throughout the body and are picked up and distributed in the bloodstream. From the blood, they exchange into the air in the lungs and are then exhaled in breath. Exogenous VOCs can be produced by the gut microbiome and therefore can be key gut health indicators, meaning breath analysis can provide a deeper understanding of gut health conditions. Every gut is unique, and the underlying
factors causing gastrointestinal disorders can vary widely among individuals. By highlighting the metabolic processes occurring in the gut, breath analysis sheds light on the intricate interplay between diet, gut microbiome, and physiology. This enhanced understanding can inform clinical practice and drive further research and innovation in the field of gastrointestinal disorders. Rather than relying solely on symptom-based assessments, clinicians can use the biomarkers obtained through breath analysis to guide treatment decisions and monitor response to treatments. This approach not only improves the accuracy of diagnosis but also facilitates quick adjustments to treatment plans and, in turn, optimising outcomes for patients. By shortening the diagnosis and treatment journey, novel breath analysis technologies could relieve the burden on patients and allow clinicians to make more informed decisions about patient care, as they can tailor treatment plans to address the specific needs and underlying mechanisms of each individual’s gut health condition. This personalised approach holds the
potential to improve treatment outcomes and enhance patient comfort. For example, there are three distinct variations of bacterial overgrowth in the gut: hydrogen-SIBO, intestinal methanogen overgrowth (IMO), and hydrogen sulfide-SIBO. Hydrogen-SIBO is caused by an overgrowth of bacteria that produce excess levels of hydrogen, which can be measured in exhaled breath. IMO is due to an overgrowth of microorganisms called archaea that can produce methane, which is also measurable in breath. Hydrogen sulfide-SIBO occurs due to an
overgrowth of hydrogen sulfide-producing bacteria in the small intestine. However, there is
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currently no available test to measure hydrogen sulfide in the breath. High concentrations of hydrogen sulfide in the gut have been associated with several other digestive conditions, including IBS and inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis. This is because gut bacteria that produce high levels of hydrogen sulfide can damage the delicate cells in the colon as well as interfere with the ability of gut cells to use energy molecules like short- chain fatty acids (SCFAs). A combination of these mechanisms likely plays a role in some of the gut inflammation seen in conditions such as IBD and IBS. Empowering patients to take control of their gastrointestinal wellbeing through breath analysis tools can also be facilitated through the development of at-home, portable breath analysis devices. OMED Health has recently launched its portable hydrogen and methane breath analyser, which, when combined with personalised clinician support and guidance, can allow patients to gain a deeper understanding of the connection between their gastrointestinal health and potential triggers in their lifestyle, and diet. Portable devices that replicate the
outcomes of larger, benchtop machines that patients would usually only have access to in a healthcare environment aim to reduce the burden on the NHS and remove the strain on healthcare resources. By fostering greater patient engagement and self-management, individuals can play a more active role in maintaining a healthy gut, and in turn, reduce the number of gastrointestinal disorders going undiagnosed for long periods, and improve overall health outcomes. Breath analysis technology represents a shift in the diagnosis, monitoring, and management of gut health conditions. From its current use in diagnosing
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