If you will be receiving a kit to do the Trio-Smart Breath Test, you will first have agreed that you will pay the company that provides the test whatever portion of the total cost of the test your insurance does not cover. This is a new and very good test that measures not only hydrogen and methane, as other SIBO breath tests have done for years, but also hydrogen sulfide. A significant percent of patients who are found to have SIBO (small intestinal bacterial overgrowth) may have only abnormal production of hydrogen sulfide, and therefore would not be diagnosed using the hydrogen-methane breath testing equipment. In particular, a significant group of patients with frequent diarrhea as one of their main problems will only be diagnosed as having SIBO requiring treatment if they have the Trio-Smart Breath Test that measures hydrogen sulfide in breath samples.
The Trio-Smart kit does not contain the dose of lactulose that you will need. Currently this is being provided by prescribing it for you to pick up at your pharmacy, or a printed prescription for lactulose will be in your test kit box for you to bring to your pharmacy.
Currently, the total cost of the Trio-Smart Breath Test is $289. If you have Medicare insurance with a secondary health insurance, or if you have a Medicaid health insurance, you will not receive a bill for any balance. All other patients will receive a bill for the balance if the insurance pays less than $289. Some insurances will not cover any SIBO breath testing, and for those patients, they will be billed for $289 by the company.
The Trio-Smart Breath Test should only be performed if it has been more than 2 weeks since you have
1. finished taking oral antibiotics
2. had a colonoscopy or barium enema Xray, or
3. had bout of very severe diarrhea lasting a day or longer.
You should also stop taking probiotics at least 5 days before the test, and avoid fiber supplements for at least 2 days. If you take over-the-counter or prescription laxatives, stop them enough days before your test that you are not in the middle of responding to them when you perform the test. Avoid Pepto-Bismol, long acting peppermint such as IBGard, other herbal supplements (especially that contain oil of oregano, or berberine, which suppress the gut bacteria), for at least 2 days before the test. Avoid taking Imodium or the generic loperamide anti-diarrhea medication, or the prescription anti-cramping medications dicyclomine or hyoscyamine starting the day before the test.
Day before the test: Avoid high fiber foods such as beans, salads, and even fruit and vegetables. However, you do not need to postpone the test if you realize you had a piece of fruit or a small amount of vegetables the day before you plan to do it. Plan to have protein such as any meat, fish, eggs, or plain or firm (not silken) tofu, or seitan. Have plain carbohydrates such as rice, potato, squash, oatmeal, but try to avoid wheat. Most importantly, plan to fast, and have only water, and no candies, breath mints, gum or cough drops for a full 12 hours before you perform the test. One 6 oz glass of wine, or 12 oz beer, or one shot of hard liquor, may be consumed the day before your test.
Morning of the test: No cigarette smoking, no vigorous exercise, no lying down during the test. Have some water, and brush your teeth well either with just water, or if you use toothpaste or mouthwash, don’t swallow any, and rinse your mouth out very well with water.
You will need: a timer set for 15 minutes (cell phone clock timer or other timer), a cup of water, your 10 gm dose of lactulose, and the Trio-Smart Breath Test kit. Note: pharmacies do not always measure the exact 15 ml or one tablespoonful of lactulose; there may be more than that in the container you pick up at your pharmacy. Be sure to use a measuring spoon that is 1 tablespoon (1 tbsp) or 15 ml to put the correct amount of lactulose in the cup of water for the breath test.
The kit will contain instructions, and here is a link to the video explaining how to use the kit:
Once you complete the test, follow the instructions to pack the 9 breath sample bags in the supplied larger bag, and then into the box in which the kit was sent to you. Use the supplied FedEx or UPS or other shipping label, and bring the completed test kit box to the correct shipping office to send it back within a day or two of completing the test. Once the samples are evaluated, the report will be sent to the requesting provider.