My question is regarding a repeat lactulose hydrogen breath test. The first test from five months ago was suggestive of SIBO with a peak in hydrogen of 34 before 120 minutes. Methane was 5 to 7 throughout the test. When the patient repeated the test, she had zeros for both gases for the whole three hours with the exception of a 1 for hydrogen at only one point throughout the test. Am I correct to suspect hydrogen sulfide in this case, despite the first test result being quite different from the second one?

Dr. Amy Nett: I think it’s a little bit difficult to answer because I’m not sure what the symptoms were and I’m not sure what the treatment was in the five months intervening. You did one test that was suggestive of SIBO with hydrogen of 34 and methane 5 to 7 and then five months later repeated the test. If you did some sort of treatment and then she had zeros for both gases, I would wonder, if she didn’t have symptoms, why not just think that that was actually due to treatment, successful treatment. So I guess I would say, what were her symptoms and why are you suspecting hydrogen sulfide? That would be my question. Yeah, I mean, hydrogen sulfide you can think about when you see all zeros, but if you’ve just done treatment, I don’t know that you can as easily make that assumption. A little bit trickier.