Hydrogen and Methane Breath Test (HMBT) for Bacterial Overgrowth and / or Lactose Intolerance

Breakfast:

• Dry white toast or bread (no butter or margarine)

• 2 x Poached, boiled, or scrambled eggs (no milk, butter, or margarine)

• Black tea, black coffee or plain, still water (no milk, sugar, or sweetener)

Lunch:

• Grilled chicken, pork, fish, seafood, (no batter) or egg sandwich on white bread (no butter / margarine)

• Black tea, black coffee or plain, still water (no milk, sugar, or sweetener)

Evening meal

• White rice

• Grilled chicken, pork, fish, seafood, (no batter) or egg

• Black tea, black coffee or plain, still water (no milk, sugar, or sweetener)

Additional drinks: • Black tea, black coffee or plain, still water (no milk, sugar, or sweetener)

It is extremely important that you follow the restricted diet and avoid all fruit, vegetables, onions, beans, bran etc. If you do not follow the restricted diet the investigation will be rescheduled.

12 hours before:

• Please do not have anything to eat in the 12 hours before the test. You are allowed minimal water (about 100ml per hour) but please do not drink anything in the hour before the test.

On the morning of the test:

• If possible please take your normal medication after the test. If you need to take any medication before the investigation, please use a minimal amount of water.

• Brush your teeth well but please don’t swallow any of the toothpaste.

• Do not smoke, this includes all types of cigarettes, e-cigarettes, vapes etc.

• If possible, please do not use any denture adhesive.

• If you have been prescribed an inhaler or angina spray, please bring this to the appointment with you.

You should have been contacted by the GI Physiology Department prior to receiving this letter to discuss any required changes to your diabetic medication. You will have received a morning appointment, if this is not the case, please contact the GI Physiology Department on 01253 953715.

If your blood sugar falls to around 5.0 mmol/L or less or if you experience hypoglycaemic symptoms (e.g. sweating, shaking, palpitations, nausea, headache, speech difficulty, confusion etc.), take 15-20 grams of carbohydrate in a sugary drink such as 200mls of Glucose (Lucozade) drink or 150mls of non-diet fizzy drinks such as cola. Then recheck the blood glucose 15 minutes after. It is important that you do not drive yourself to/from the appointment if your blood glucose level is below 5.0mmol/L.

Please bring your diabetic medication, your blood glucose monitor, and some food to the appointment. You will be able to have this once the test is finished.

It is advisable that you do not drive yourself to the appointment.

A HMBT is a non-invasive, safe, and painless test. Your doctor may have sent you for a breath test to investigate symptoms of bloating, diarrhoea and/or abdominal discomfort. Depending on your symptoms you may be referred for:

• A glucose or lactulose breath test for bacterial overgrowth (abnormal growth of bacteria in the small bowel which can cause symptoms of nausea, diarrhoea, bloating, gas, and abdominal pain).

• A lactose breath test for lactose intolerance (where the sugar found in dairy products causes gastrointestinal symptoms when consumed).

• On arrival the test will be explained, and you will be asked to give your consent.

• You will be asked to use a mouthwash and blow into a machine to give some breath samples.

• If your initial breath samples are too high you will be asked to come back on a different day. You would be advised to follow the restricted diet for 2 days and follow an 18 hour fasting period.

• You will be asked to drink a cup of water mixed with either glucose, lactose, or lactulose.

• Breath samples will be taken at intervals of 15, 20 or 30 minutes for up to 4 hours.

• Occasionally during the test some people may experience symptoms such as, diarrhoea or bloating. You will be asked about these symptoms during the investigation.

• After the test you may resume your normal activities.

You will be given an indication of the results on the day. However, the formal results and any required treatment plan will be provided by the Consultant.

A glucose/lactulose breath test for bacterial overgrowth takes 2-3 hours. A lactose breath test for lactose intolerance takes 3-4 hours.

It is recommended you bring something with you to pass the time e.g., magazines or a book. You might want to bring some food and a drink to have once the test has finished. Please make sure you do not eat or drink anything until the test is finished.

It is important you are on time for the investigation, late arrival may mean there is insufficient time to complete the investigation resulting in its cancellation. It is advisable that if you are arranging transport through the GP, you tell them your appointment time is 30 minutes earlier to allow for any transport delays.

No, unfortunately the tests need to be done on separate days. If you are coming for both tests the bacterial overgrowth breath test will always be done first.

Please go to the GI Physiology Department, this is in the Gastroenterology and Endoscopy Building (Area 6) of Blackpool Teaching Hospital.

Please call the GI Physiology department on 01253 953715 if you have any questions about which of your current medications need to be stopped.

There is an answer machine available 24 hours a day, if you leave your name and a contact number your call will be returned as soon as possible.