A retrospective analysis of patients on a waiting list for small intestinal bacterial overgrowth (SIBO) breath testing during the COVID-19 pandemic and introduction of a home testing pathway

Introduction: Small Intestinal bacterial overgrowth is an important differential in patients having persistent diarrhoea, bloating and abdominal pain. The most common first line investigation is a Hydrogen Breath test (HBT) an aerosolising procedure which as a result of COVID-19 has led to cessation of the service in many centres. Aims & Methods: We introduced a home testing service for SIBO where HBT kits are mailed to patients with instructions and returned back for analysis. The aim of this study was to investigate the symptoms and treatments received by patients on our waiting list as well as their feedback to the new home testing service using qualitative survey questions. This was a retrospective analysis of patients on the HBT waiting list at a teaching hospital in the UK in November 2020. Patient medical records were analysed and symptoms, risk factors and antibiotic therapy received were recorded and statistical analysis was performed using Microsoft Excel. Results: A total of 108 patients (M 42: F 66) were on the waiting list for a hydrogen breath test. 8 patients were excluded due to symptom resolution, discharged from clinic or cancellation of request. 50 (50%) referrals were for the indication of bloating with the other most common indications being of diarrhoea 35 (35%) and abdominal pain 15 (15%). The average wait time from referral to HBT was 8 months (range 0.76-19.04). 88 (88%) consented to home testing for SIBO. 86.4% (76/88) reported to still be symptomatic with 13.6% (12/88) reporting no longer having symptoms. 8 patients had received antibiotics (Metronidazole and Ciprofloxacin) whilst awaiting their SIBO investigation with 2 patients reporting symptom resolution following treatment. The preliminary pilot sent out 39 home testing kits. 14 home kits had been returned with patient feedback survey after 20 days. A satisfaction rating scale was used in the surveys returned. Conclusion: There has been a significant impact on our waiting list for patients requiring breath testing to diagnose SIBO due to COVID and despite this very few patients appear to receive empirical antibiotic treatment with the majority reporting ongoing symptoms. Our initial pilot study of a home HBT service indicates good patient engagement and satisfaction and suggests this may be a promising and viable long term option for SIBO diagnosis in the COVID era.