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Bacterial Overgrowth (Sibo) Analytical Record Patient Name or #: Date of Test: Weight: DOB: Notes: Substrate Given Nurse Referring Physician Symptoms (Check All That Apply): Nausea Weight Loss Diarrhea.

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  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Enter the patient name or number in the designated field to identify the individual for whom the test is being performed.
  3. Input the date of the test in the appropriate section to record when the test occurred.
  4. Fill in the weight and date of birth fields to provide additional patient information essential for analysis.
  5. Document the substrate given, the name of the nurse assisting, and the referring physician in the respective fields to ensure accurate follow-up and record-keeping.
  6. Check all symptoms that apply from the list provided. This information is crucial for medical evaluation.
  7. Record the baseline values and subsequent measurements for H2 and CH4, including CO2 percentages, at specified time intervals. This data is vital for interpreting the results.
  8. Complete the final readings as indicated after all sampling times to ensure all measurements are accounted for.
  9. Ensure to have the physician sign the form in the designated area to validate and authorize the test results.
  10. Once completed, you can save changes, download, print, or share the form as needed.

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Rise in hydrogen by 20 ppm above basal after lactose ingestion is considered as positive lactose HBT. Failure of blood sugar to rise by 20 mg/dL at 30 minutes after ingestion of lactose is considered as positive lactose tolerance test, which is indicative of lactose malabsorption.

A positive breath test will present two peaks; an early H2 or CH4 peak, representing the bacterial fermentation of in the small intestine, and the late peak due to exhaled H2 or CH4 as a consequence of colonic bacterial metabolism, which is normal (10-12).

The QuinTron breath test is a diagnostic procedure used to analyze the gases present in the digestive tract by measuring their level of concentration in the patient's breath. At Hattiesburg GI Associates, PLLC, we evaluate individuals' breath samples for three types of gas: hydrogen, methane, and carbon dioxide.

So, a breath hydrogen test showing a rise after consuming glucose will mean that there are too many bacteria in the small bowel (i.e. bacterial overgrowth is present).

If there is a rise in hydrogen of 20 p.p.m. (parts per million) from baseline within 90 minutes, this is considered positive for hydrogen-predominant SIBO. Positive for intestinal methanogen overgrowth. A level of at least 10 p.p.m at any time is considered positive for intestinal methanogen overgrowth.

Medical professionals agree that the glucose hydrogen breath test is the best option available to test for SIBO. Glucose is more sensitive than to a wide range of bacteria, can be ordered online without a physician and unlike is not a prescription laxative.

A rise of ≥ 20 ppm from baseline in hydrogen by 90 min should be considered a positive test to suggest the presence of SIBO. A peak methane level ≥ 10 ppm at any point is indicative of a methane-positive result. NR=Non-Reportable due to analyte outside the reportable range.

What if I have a Positive SIBO Breath Test? Conventional and alternative treatment options exist for small intestinal bacterial overgrowth. Gastroenterologists typically treat SIBO with oral antibiotics. Most physicians use standard doses of oral antibiotics for one to two weeks.

4:22 6:40 QuinTron EasySampler At-Home Breath Collection Overview (SIBO ... YouTube Start of suggested clip End of suggested clip Include the sample number date time and your name affix the label to the vial as shown. Here thenMoreInclude the sample number date time and your name affix the label to the vial as shown. Here then insert the vial into the bubble bag. Please do not place more than five vials in each bubble. Bag.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232