Breath Testing Done Right
A practical playbook for GI practices
Turn hydrogen and methane breath testing from a workflow headache into a reliable diagnostic pathway for SIBO, IMO, and carbohydrate malabsorption.
Written for
- GI groups and hospital-affiliated practices treating high volumes of functional GI patients
- Gastroenterologists and APPs who want curves they can trust and clear answers
- Service line and practice leaders who need breath testing to work clinically, operationally, and economically
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The problem
When breath testing doesn't work the way it should
Most GI practices don't lack access to breath testing. They lack a program that works.
You've probably seen at least one of these:
- 01Kits that go out but never come back
- 02Curves that feel unstable or unreliable
- 03Prep and protocol that vary by provider or site
- 04Staff pulled into managing 2–3 hour in-office tests
- 05Reports that arrive late, with no clear next step for the visit
The result: breath testing becomes a side project instead of a dependable diagnostic pathway for IBS-like symptoms, SIBO/IMO, and carbohydrate malabsorption. This guide walks through what breath testing done right looks like when you treat it as a program, not just a kit.
What's inside
A four-domain blueprint for the full breath-testing pathway
Each domain builds on the one before it. Clinical integrity makes a curve worth reading. Protocol integrity makes it repeatable. Operational performance gets the test back. Economic yield decides whether the program holds up.
Clinical integrity
Make sure every curve is something you can act on.
- Why CO₂ correction and sample stability matter
- How test sensitivity and specificity affect your confidence
- How to align breath testing with major GI guidelines
Protocol integrity
Standardize how tests are run, not just how they're ordered.
- Patient prep that fits real-world workflows
- Substrate choice and timing that reduce false noise
- Common pitfalls that quietly erode protocol quality
Operational performance
Stop losing tests, and time, between the order and the report.
- The 7-step HMBT pathway from order to act
- Registration as a control point instead of a paperwork chore
- How to improve your test return ratio without adding staff
Economic yield
Make every ordered test count.
- The real cost of unreturned or uninterpretable tests
- How to think about completion, leakage, and reimbursement
- Turning breath testing into a sustainable program, not a loss leader
Who this helps
Built for GI, useful across the functional GI community
Integrative and functional clinics
Practices sending out high volumes of GI testing that need protocols to hold up across providers.
Naturopathic doctors and dietitians
Clinicians who want guideline-aligned breath testing without trading down on science.
Any clinician standardizing a pathway
Anyone who wants breath testing to be a clear, repeatable part of their diagnostic playbook.
Why CDI wrote this guide
We see what separates programs that work from programs that stall
Commonwealth Diagnostics International is a CLIA-certified functional GI diagnostics lab focused on hydrogen and methane breath testing. Whether or not you work with CDI today, these are the principles we believe any high-performing breath-testing program should follow.
This playbook is built from
- Tens of thousands of breath tests processed annually, with CO₂ correction and results delivered within 1 business day of sample receipt.
- Real-world migrations helping GI groups move from room-blocking, in-office testing to scalable at-home programs.
- A commitment to predictable patient cost, with a max $299 out-of-pocket cap on breath tests.
Questions
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Get the playbook your team can actually use
Forty-five pages on clinical integrity, protocol, operations, and economic yield, written for practices that want breath testing to hold up.
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