Written by Melissa Dooley, GastroLife
This article reflects the opinions of a healthcare professional. The views expressed are their own. The intended use for the GastroCH4ECK® is to aid in the diagnosis of the following disorders:
- Lactose Intolerance,
- Small Intestinal Bacterial Overgrowth (SIBO).
Each year on the 29th of May, World Digestive Health Day highlights the importance of gastrointestinal wellbeing. It is also an opportunity to reflect on how innovation continues to improve the assessment of digestive disorders.
Over the past two years, I have contributed to Bedfont® Scientific’s World Digestive Health Day publications. In 2024, we explored the importance of structured investigation and the risks of self-diagnosis in digestive health1. In 2025, Bedfont® examined the science behind hydrogen-methane breath testing (HMBT)2 and its role in identifying small intestinal bacterial overgrowth (SIBO) and carbohydrate malabsorption.
In 2026, we are looking at progress, for example, how HMBT has evolved, and how diagnostic technology such as the GastroCH₄ECK® is advancing non-invasive gut diagnostics.
The Evolution of HMBT
Historically, SIBO diagnosis relied on jejunal aspirate culture. This is an invasive, technically demanding, impractical procedure in routine care, and not cost-effective. Breath testing emerged as a patient-friendly test for diagnosing small intestinal bacterial overgrowth and carbohydrate malabsorption, though early adoption was limited by a lack of standardisation.
The publication of the North American Consensus in 2017 outlined recommendations around preparation protocols, substrate dosing and diagnostic thresholds.3 This was reinforced by the American College of Gastroenterology (ACG) Clinical Guideline in 2020, which formally recognised breath testing as a clinically appropriate tool in selected patients.4
These publications moved breath testing into a supported, structured diagnostic approach (provided that testing is carried out using recommended protocols, reliable analysers, and appropriately trained practitioners).
Standardisation in Clinical Practice
Breath testing literature highlights that HMBT must be performed according to recommended preparation protocols and interpreted in a clinical context.3
Importantly, device accuracy and reliability play a critical role in minimising variability. Advances in sensor technology and calibration systems have improved reproducibility across clinical settings, strengthening user confidence in breath testing as a diagnostic tool.
Expanding Access: Clinic and Home-Based Testing
Evidence suggests that home-based breath testing, when supported by appropriate testing instructions, can achieve high completion and reliability rates.5
This enables flexibility across both clinic-based workflows and home testing pathways, broadening access to diagnostic investigations while maintaining clinical confidence.
The following are some examples of commonly asked questions in relation to HMBT:
- Is hydrogen-methane breath testing reliable for diagnosing SIBO?
When performed according to recommended protocols and interpreted alongside clinical assessment, breath testing is considered a valuable diagnostic tool
- Why is methane measurement important?
Methane levels ≥ 10 ppm are indicative of intestinal methanogen overgrowth and are often linked to constipation-related symptoms.4 Measuring methane alongside hydrogen enhances diagnostic precision by identifying patients whose symptoms may not be explained by hydrogen-producing bacterial overgrowth alone.
- What influences diagnostic accuracy?
Recent antibiotics, bowel prep, motility agents, and dietary non-compliance may affect results. Adherence to established protocols is very important.
Looking ahead, several important developments are expected to influence the next phase of breath testing:
- Further international harmonisation of testing protocols, including guidance from organisations such as the British Society of Gastroenterology.6
- Enhanced multi-gas detection capabilities, potentially expanding beyond hydrogen and methane.
- Greater precision in patient selection, improving cost-effectiveness and clinical outcomes.
Conclusion:
HMBT has evolved to a structured, consensus-supported diagnostic tool. Advances in clinical understanding, combined with ongoing innovation in diagnostic technology, have strengthened its role in assessing SIBO, IMO, and carbohydrate malabsorption.
As we mark World Digestive Health Day 2026, continued innovation will remain central to advancing digestive healthcare worldwide.
Gastrolyzer® range of HMBT devices:
The Gastrolyzer® range of devices, comprising the Gastro+™ hydrogen breath testing device and the GastroCH4ECK® have been helping to detect gastrointestinal disorders for over 30 years.
The Gastro+™ is a portable, handheld hydrogen device for quick, easy breath analysis. Tests can be conducted with a mouthpiece or a facemask for infants or elderly patients who struggle to hold their breath.
The GastroCH4ECK® is the only HMBT device with direct breath testing, allowing you to take a reading on the spot with instant results. It also offers remote testing by collecting breath samples in a breath bag for analysis at a later date.
The Gastrolyzer® range helps to streamline workflows in clinics and guide treatment decisions effectively. To learn more about the Gastrolyzer®, visit the educational portal here.
References:
- Bedfont® Scientific (2024) ‘World Digestive Health Day 2024: Taking control of your digestive health – importance of not self-diagnosing’. Available at: https://www.bedfont.com/world-digestive-day-understanding-gut-health-and-the-power-of-hmbt/ (Accessed: 23rd February 2026)
- Bedfont® Scientific (2025) ‘World Digestive Day: Understanding gut health and the power of HMBT’. Available at: https://www.bedfont.com/world-digestive-day-understanding-gut-health-and-the-power-of-hmbt/ (Accessed: 23rd February 2026)
- Rezaie, A., Buresi, M., Lembo, A. et al. (2017) ‘Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American Consensus’, The American Journal of Gastroenterology, 112(5) pp 775–784
- Pimentel, M., Saad, R.J., et al (2020) ‘ACG clinical guideline: small intestinal bacterial overgrowth’, The American Journal of Gastroenterology, 115(2), pp. 165–178
- Pitcher, C. et al. (2022) ‘Hydrogen and Methane Breath Tests can be performed by patients independently at home with >95 % success rate’, Available at: https://gut.bmj.com/content/71/Suppl_1/A185.2 (Accessed: 24 February 2026).
- British Society of Gastroenterology (BSG) ‘AGIP protocol for hydrogen and methane breath testing’. Available at: https://www.bsg.org.uk/clinical-resource/agip-protocol-for-hydrogen-methane-breath-testing (Accessed: 26th February 2026).
