Usefulness of a Digital Tool to Improve Methodology and Reporting of Breath Tests for Small Intestinal Bacterial Overgrowth

Goals: We aimed to determine if the use of a web-based digital tool could improve methodology and reporting of breath tests (BT). Background: Although BT represent a noninvasive and low-cost tool for the diagnosis of small intestinal bacterial overgrowth (SIBO), lack of standardization and poor test performance have been described. Methods: We performed a retrospective analysis of a consecutive series of BT reports from 8 different gastroenterology units during the period April 2024 to July 2024. Data from the BT reports was extracted, masked, and uploaded in a digital tool that supports the entire breath test process and creates a report. Three experts in SIBO who were blinded for the test interpretation determined a diagnosis for each patient and delineated a total of 12 quality items that considered relevant to be included in a BT report. The main outcomes of the study were accuracy (ie, proportion of correct diagnoses) and quality of BT reports. Results: A total of 210 BT were analyzed; the type of substrate was informed in 187 (89.0%) BT and lactulose was used in most of the studies (162/187, 86.6%). Most tests measured only hydrogen (89.5%) and 38 (18.1%) extended the BT for <90 minutes. SIBO was diagnosed in 92 (43.8%) and 79 (37.6%) patients in the original BT report and the digital tool report, respectively. As compared with the diagnosis by the expert gastroenterologists and current guidelines, the original report was accurate in 182 (86.6%) patients and the digital tool report in 210 (100%) patients ( P <0.0001). Regarding quality of reporting, the original BT report had a median of 5 (3 to 8) items included and the digital tool report described a median of 9 (7 to 11) items ( P <0.0001). Conclusions: Breath tests methodology and interpretation for the diagnosis of SIBO are heterogenous and do not comply with current guidelines. The use of a web-based digital tool specifically developed to assist the entire BT process appears to improve accuracy and quality of reports.