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SIBO breath test: what guidelines say and what it costs

A SIBO breath test measures hydrogen and methane in your breath after you drink a sugar solution. Here is what the main gastroenterology guideline says about breath testing, what the tests we track actually are, and what they cost (checked Oct 19, 2026).

What the test measures

Hydrogen and methane in exhaled breath, collected at intervals after drinking a lactulose solution, to look for bacterial overgrowth in the small intestine (per lab and seller descriptions).

What the guidelines say

The American College of Gastroenterology's 2020 guideline on small intestinal bacterial overgrowth (SIBO) makes these suggestions about breath testing. All are conditional recommendations based on very low quality evidence:

• "We suggest the use of breath testing (glucose hydrogen or lactulose hydrogen) for the diagnosis of SIBO in patients with IBS."
• "We suggest against the use of breath testing for the diagnosis of SIBO in asymptomatic patients on PPIs" (proton pump inhibitors, a type of acid-reducing medicine).
• For people with constipation, it suggests testing for methane using glucose or lactulose breath tests.

An earlier North American expert consensus (2017) described glucose and lactulose breath tests as the least invasive way to test for SIBO, noted that indications, methods and interpretation had not been standardized, and proposed standard doses and cut-offs (for example, a hydrogen rise of at least 20 ppm by 90 minutes, or methane of at least 10 ppm). Our evidence level for this test: Widely used, with known limits.

Glucose and lactulose are the two sugars used. Our price table compares 3-hour lactulose breath tests, most of them from Genova Diagnostics. Whether and how to test is a question for a clinician; this page is not a recommendation.

How much does a SIBO breath test cost?

At the sellers we track, a SIBO breath test kit cost $235–$359 across 9 listings from 9 sellers, including listed fees. The lowest price open to the public was $249 (Direct Laboratory Services (DirectLabs)). See the full SIBO breath test price table for who can order, state limits and notes.

Insurance and HSA/FSA

Genova Diagnostics says that for in-network commercial plans it "will submit claims on your behalf when coverage is indicated", and that Medicare "only covers laboratory services defined as medically necessary". That applies to tests ordered through a healthcare provider; the kit prices above are the sellers' listed prices. For HSA and FSA accounts, the IRS counts "laboratory fees that are part of medical care" as medical expenses; check with your plan administrator.

Compare prices

• SIBO Breath Test: 9 prices, $235–$359
• GI-MAP: 8 prices, $320–$499
• GI Effects: 8 prices, $449–$627.75

Sources

1. Pimentel M, Saad RJ, Long MD, Rao SSC. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Am J Gastroenterol. 2020;115(2):165-178. https://doi.org/10.14309/ajg.0000000000000501
2. Rezaie A, et al. Hydrogen and Methane-Based Breath Testing in Gastrointestinal Disorders: The North American Consensus. Am J Gastroenterol. 2017;112(5):775-784. https://pmc.ncbi.nlm.nih.gov/articles/PMC5418558/
3. Genova Diagnostics: Billing Options https://gdx.net/billing
4. IRS Publication 502, Medical and Dental Expenses (section "Laboratory Fees") https://www.irs.gov/publications/p502

Sources checked 2026-10-19. Prices are from our price tables and update when we re-check sellers.

Informational only, not medical advice. See about & disclaimer.