{"version":"v1","contradiction":{"id":"are-sibo-breath-tests-valid","question":"Are lactulose / glucose breath tests a valid diagnostic for SIBO?","summary":"Breath testing dominates clinical practice but has poor specificity against jejunal aspirate culture. The disagreement is whether they remain useful as pattern-recognition tools or should be abandoned.","positions":[{"id":"breath-tests-clinically-useful","label":"Breath tests remain clinically useful","thesis":"Despite imperfect operating characteristics, gas patterns (H₂, CH₄) discriminate clinically meaningful subgroups and guide therapy.","predicts":["Therapeutic response correlates with breath-test pattern."],"supportingEvidence":["Pimentel-group rifaximin response correlates with H₂ pattern in IBS-D."],"weakeningEvidence":["High false-positive/-negative rates against aspirate culture; transit time confounding."],"authorPosition":"considered-plausible","evidenceLevel":"emerging"},{"id":"breath-tests-misleading","label":"Breath tests are mechanistically misleading","thesis":"Breath tests measure microbial fermentation kinetics, not overgrowth per se; they entrench composition-first thinking and miss the host-bioenergetic lesion.","predicts":["Patient outcomes are not improved by breath-test-driven therapy versus mechanism-guided care."],"supportingEvidence":["ACG guideline acknowledging poor specificity; relapse rates after breath-test-positive antibiotics."],"weakeningEvidence":["No head-to-head outcome trial comparing strategies."],"authorPosition":"preferred","evidenceLevel":"hypothesis"}],"unresolvedQuestions":["Does mechanism-guided care without breath testing produce better long-term remission?"],"arbitratingExperiments":["Pragmatic trial of breath-test-guided vs. mechanism-guided management in recurrent SIBO with 12-month relapse as endpoint."],"relatedConcepts":["sibo-host-capacity-model"],"relatedArticles":["why-sibo-breath-tests-are-fundamentally-unreliable-and-how-t"],"relatedClaims":["sibo-breath-tests-have-poor-specificity"],"lastReviewed":"2026-05-11"}}