Commonwealth Diagnostics International

Commonwealth Diagnostics International CDI offers products and services that aid the diagnosis of small intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS).

Founded in 2015 in Salem, Mass., and operating out of its CLIA-certified laboratory and as an FDA-registered, ISO 13485-certified medical device manufacturer, Commonwealth Diagnostics International (CDI) helps providers identify and diagnose common sources of digestive distress and functional gastrointestinal ailments. CDI’s expansive portfolio of non-invasive at-home hydrogen and methane breath t

ests supports the diagnosis and treatment of Small Intestinal Bacterial Overgrowth (SIBO) and Intestinal Methanogen Overgrowth (IMO), as well as fructose malabsorption, lactose malabsorption, and sucrose malabsorption. Focused on patient-centric principles, CDI breath tests are easy-to-use, quick, and safe for patients and support meaningful GI health outcomes by helping steer each practitioner’s approach to dietary modification, homeopathic remedies, nutritional supplementation, immune support, high-quality probiotics, and additional testing.

Most clinicians still call it methane SIBO. The terminology has moved — and the distinction matters clinically.Intestina...
04/24/2026

Most clinicians still call it methane SIBO. The terminology has moved — and the distinction matters clinically.

Intestinal Methanogen Overgrowth (IMO) is now the industry-standard term, and the reason is more than semantic. Methanogens are not bacteria — they belong to the Archaea kingdom. They also tend to colonize the colon, not the small intestine, which is why fitting them into the SIBO framework has always been an imperfect diagnosis.

The ACG's Clinical Guidelines now formally recognize IMO as a distinct condition, defined by methane levels of ≥10 ppm at any point during a hydrogen and methane breath test.

For clinical practice, this distinction changes how you frame the diagnosis, communicate with patients, and document findings:

⮞IMO presents with constipation-predominant symptoms — distinct from hydrogen-driven SIBO
⮞Methane ≥10 ppm at any point in the test, not just within the first 90 minutes
⮞Separate ICD-10 coding now exists for IMO — documentation accuracy matters

How CDI supports accurate IMO testing:
⮞Hydrogen and methane breath testing measures both gases simultaneously → one test, two diagnoses ⮞differentiated
⮞At-home, non-invasive collection → no facility visit required for patients or families
⮞Available for both adult and pediatric patients → full population coverage in one program

Terminology evolves when the science demands it. IMO is not a rebranding — it is a more accurate clinical framework.

Full IMO and SIBO testing overview → commdx.com/breath-testing-for-sibo-imo/

04/22/2026

The North American Consensus on breath testing and the ACG Clinical Guidelines for SIBO exist — but in a practice seeing 20 patients a day, dense protocol documents rarely change how a clinician works on a Tuesday afternoon. What changes workflow is a clear, practical frame around a single decision point.

That is exactly the tension Dr. Hetal Karsan named in a recent conversation: "No one's reading all these guidelines. There's so many of them and it's so boring, to be quite honest, and no one flips through all these pages." The answer, he and his colleague found, was case-based learning — taking the salient points and bringing them to life in a way clinicians can actually remember and apply.

For breath testing, that single decision point is often this: when a patient presents with bloating, altered motility, or IBS symptoms that look the same on paper, does your workflow have a clear path to an objective test — or does it default to empiric treatment?

What that decision framework looks like in practice:
⮞Identify the symptom cluster that warrants SIBO/IMO workup — bloating, abdominal pain, bowel changes, prior antibiotic exposure
⮞Select substrate based on clinical question — glucose for proximal small intestine, lactulose for full transit
⮞Interpret using current thresholds — hydrogen ≥20 ppm within 90 minutes, methane ≥10 ppm at any point

How CDI supports clinical integration:
√ Detailed provider resources and protocol guides → ready to use in clinical education and onboarding
√ At-home, non-invasive collection → removes scheduling friction for patients and staff
√ 24-hour turnaround with results delivered directly to your portal → faster decisions, fewer delays

Guidelines inform. Cases teach. Workflows decide.

Full protocol and substrate selection guide here → commdx.com/breath-testing-for-sibo-imo/

When patients describe at-home breath testing as "turnkey," that is a signal worth sharing with your practice team.One p...
04/20/2026

When patients describe at-home breath testing as "turnkey," that is a signal worth sharing with your practice team.

One patient recently noted:
"The test was easy to follow and everything was well organized. Be sure to set aside time for the fasting period and the test itself will run about 3 hours. They did a nice job making this a turnkey DIY home test."
— James Ewan Verified 5-star Google review

That last detail matters. This patient understood the time commitment, prepared for it, and completed the test — because the process was clear enough to set accurate expectations before they even started.

When patients know what to expect, they follow through. That means fewer incomplete tests, fewer abandoned kits, and more results reaching your desk.

How CDI supports patient readiness:
✔Step-by-step prep guides and instructional videos — clear expectations from the moment the kit ships
✔At-home, self-administered collection — no facility visit, no scheduling friction
✔Automated email and SMS reminders — patients stay on track without your staff intervening
✔Real-time kit tracking in MyGI Gateway — so your team always knows where a test stands

If you would like to see exactly what your patients receive from CDI, our Provider Relations team can walk you through the full experience.

Carbohydrate malabsorption is not an afterthought in the functional GI workup. A recent study in The American Journal of...
04/17/2026

Carbohydrate malabsorption is not an afterthought in the functional GI workup. A recent study in The American Journal of Gastroenterology found that 59.1% of patients with disorders of gut-brain interaction met criteria for carbohydrate intolerance — and those patients carried higher IBS symptom scores, more diagnoses, and lower quality of life than non-intolerant patients.

The data also confirm that lactose and fructose malabsorption measured on standardized breath tests are independently associated with symptom-defined carbohydrate intolerance. That is not a lab artifact — it is a clinically meaningful finding that directly supports adding substrate-specific breath testing to your DGBI pathway alongside SIBO and IMO.

What that means in practice:
✓Treat carbohydrate malabsorption as a first-class diagnostic step — not an optional add-on after SIBO and IMO are ruled out.
✓Use standardized, consensus-aligned protocols — defined substrate doses, serial sampling, and validated gas measurement are what the evidence supports.
✓Pair objective malabsorption data with the broader clinical picture — results should inform the conversation, not replace it.

How CDI supports:
✓Lactose, fructose, and sucrose malabsorption breath testing under one standardized program → comprehensive carbohydrate workup without multiple orders.
✓CLIA-certified lab with gas chromatography and CO₂ correction → results that reflect the same rigor affirmed in top-tier GI literature.
✓1 business day result turnaround → data arrives in time to influence the next clinical decision.

Standardized testing → clinically meaningful data → clearer next steps for your DGBI patients.

Full evidence spotlight here → https://commdx.com/carbohydrate-malabsorption-breath-testing-evidence-spotlight/

04/15/2026

Knowing which microbes live in the gut is only part of the diagnostic picture. What matters clinically is what those microbes are actually doing — and that distinction is where hydrogen and methane breath testing becomes indispensable.

As Jordan Haworth, GI physiologist at the Functional Gut Clinic, explained on the Modern Gastro Podcast: when we do a hydrogen and methane breath test, we are looking at the metabolome — the consequences of microbial activity — not just the microbiome itself. Gut bacteria fermenting undigested carbohydrates produce hydrogen and methane gas, and those gases can be directly linked to specific symptoms.

That distinction changes how you approach the workup:
Symptom patterns alone cannot tell you whether fermentation is occurring or which substrate is driving it — breath testing measures that activity directly.
Hydrogen and methane measure different microbial processes: elevated methane is associated with distinct clinical patterns, including constipation, that hydrogen alone would not capture.
Objective fermentation data gives the diagnostic conversation a confirmed starting point rather than an assumption.

How CDI supports:
Hydrogen and methane breath testing for SIBO, IMO, and carbohydrate malabsorption → substrate-specific metabolic data across the most common functional GI diagnoses.
Research-validated methodology → results grounded in current evidence, including North American Consensus guidelines.
Non-invasive, at-home collection → accessible for the patients most likely to need ongoing functional GI evaluation.

Metabolome over microbiome.
That is the shift.

Full episode with Jordan Haworth here → https://commdx.com/episode-6-of-the-modern-gastro-podcast/

When a patient calls support mid-test and gets through immediately — no wait, no confusion, just a clear answer — that i...
04/13/2026

When a patient calls support mid-test and gets through immediately — no wait, no confusion, just a clear answer — that is the moment that determines whether the kit gets completed or quietly set aside.

Here is what one CDI patient shared recently:
"When the initial kit instructions felt overwhelming, I called their support line. The representative was immediately comforting and professional, patiently walking me through every step. The support line was consistently accessible with zero wait time for any follow-up questions."
— Verified Google review

When patients know that help is one call away — and that the call will actually be answered — the barrier to completing at-home testing drops significantly. That means fewer incomplete kits, fewer inbound calls to your office, and a more reliable return on every test your practice distributes.

How CDI supports that experience:
Live patient support line → questions answered directly without routing to your staff.
Step-by-step prep instructions included with every kit → patients have a reference before they ever need to call.
Automated status notifications → patients stay informed from dispatch through results without additional follow-up.

If you would like to see the materials and support patients receive from CDI, our team can walk you through the full experience. → https://commdx.com

Every breath test your practice orders generates data. The question is whether you can see that data clearly enough to a...
04/10/2026

Every breath test your practice orders generates data. The question is whether you can see that data clearly enough to act on it — or whether kits are quietly going missing between order and result.

MyGI Gateway is CDI's centralized portal for managing the full breath testing lifecycle, from ordering through tracking to results review. It gives your team a single view of every test in progress so gaps are visible before they become incomplete charts.​

What changes when your practice uses MyGI Gateway:
Ordering, tracking, and results are in one place → no switching between systems or chasing status updates by phone.
Real-time notifications → your team knows when a kit ships, when it is received, and when results are ready — without manual follow-up.
Secure data sharing within your team → results are accessible to the right people without additional coordination.

How CDI supports:
MyGI Gateway is free for both providers and patients → no cost barrier to operational visibility.
Supports all CDI hydrogen and methane breath tests → SIBO, IMO, and carbohydrate malabsorption testing in one platform.
Intuitive interface → minimal onboarding time for your staff.

Better return ratios start with knowing where every kit stands. See how MyGI Gateway supports the full breath testing workflow →
https://commdx.com/mygigateway/

04/08/2026

"GI is this beautiful blend between surgery and internal medicine." That observation from Dr. Brennan Spiegel, gastroenterologist and researcher at Cedars-Sinai, points to something that shapes how GI workups need to be designed — not as isolated procedural decisions, but as a reflection of the full clinical picture.​​

For Dr. Spiegel, that blend also includes the brain-gut axis — the relationship between biopsychosocial medicine and gastrointestinal health that adds another layer of complexity to functional GI diagnoses. When a patient's symptom picture crosses that intersection of structural, functional, and psychological factors, the workup has to be able to move across all of them.​​

What that means in practice:
Start with objective data before anchoring to a single diagnosis — functional GI conditions often overlap, and breath testing helps differentiate what is driving the symptom pattern.
Build the workup to account for what the patient brings into the room — not just what the chart shows.
Recognize that the path forward often depends on how much of the clinical picture is confirmed versus assumed.

How CDI supports:
Hydrogen and methane breath testing for SIBO, IMO, and carbohydrate malabsorption → objective differentiation across overlapping functional GI conditions.
Research-validated methodology → results grounded in evidence, not clinical impression alone.
Non-invasive, at-home collection → reduces barriers for patients navigating complex, ongoing workups.

Full episode with Dr. Brennan Spiegel and Dr. Hetal Karsan here →
https://commdx.com/a-guide-to-the-guidelines/

A new SIBO diagnosis is already a difficult journey. The testing process should not add to it. CDI makes at-home breath ...
04/07/2026

A new SIBO diagnosis is already a difficult journey. The testing process should not add to it. CDI makes at-home breath testing clear, supported, and timely. commdx.com

When a patient is navigating a SIBO diagnosis and managing a treatment plan for the first time, the testing experience i...
04/07/2026

When a patient is navigating a SIBO diagnosis and managing a treatment plan for the first time, the testing experience itself can either support that process or add to the burden.

Here is what one CDI patient shared recently:
"No problems at all. Plenty of tutorials online and the prep was straightforward. The company was great. 👍"
— James Coleman

Patients dealing with a new functional GI diagnosis are already carrying a significant clinical and emotional load. When the testing process is clear, at-home, and paired with timely results, it removes one barrier from an already complex picture — and gives both the patient and the clinician a confirmed starting point for the path forward.

How CDI supports that experience:
Non-invasive, at-home breath test collection → patients complete testing on their own schedule without an additional clinic visit.
Step-by-step prep instructions included with every kit → patients know exactly what to do before they begin.
Timely result delivery with automated notifications → patients and clinicians receive results without unnecessary delays.

If you would like to see the materials and support patients receive from CDI, our team can walk you through the full experience.

Breath testing has become the recommended diagnostic approach for SIBO, IMO, and carbohydrate malabsorption — and the cl...
04/06/2026

Breath testing has become the recommended diagnostic approach for SIBO, IMO, and carbohydrate malabsorption — and the clinical case for it has only strengthened since the ACG published formal guidelines.

The core challenge has not changed: symptoms alone cannot distinguish between SIBO, IMO, and carbohydrate malabsorption. They present similarly, they overlap frequently, and without objective hydrogen and methane data, the workup is working from a pattern rather than a confirmed picture.

What that means in practice:
Breath testing is not a secondary option — for functional GI differentiation, it is the recommended diagnostic step.
Hydrogen and methane measurement matters: high methane production patterns, for example, carry distinct clinical implications that a hydrogen-only test would miss.
Understanding how to read and apply breath test results — including what constitutes a valid test — is what separates objective data from inconclusive charts.

How CDI supports:
Validated hydrogen and methane breath testing for SIBO, IMO, and carbohydrate malabsorption → substrate-specific data across the most common functional GI diagnoses.
Research-validated methodology → results grounded in current evidence and ACG guidelines.
Non-invasive, at-home collection → accessible for patients without adding clinic visit burden.

If breath testing is part of your workup — or should be — this primer covers the clinical foundation worth having on hand.

Download the eBook here →
https://commdx.com/ebook/breath-testing-for-gi-related-symptoms/

Chronic, watery diarrhea, bloating, and abdominal pain are easy to attribute to IBS or carbohydrate malabsorption from o...
04/03/2026

Chronic, watery diarrhea, bloating, and abdominal pain are easy to attribute to IBS or carbohydrate malabsorption from other substrates — but when sucrose is the unidentified driver, standard workups may not catch it.

Sucrose malabsorption occurs when enzyme activity is insufficient to break down sucrose, leaving it unmetabolized in the gut where bacteria ferment it and produce hydrogen and methane gas. The symptom picture can mirror SIBO, IMO, lactose, and fructose malabsorption closely enough that substrate-specific testing is the only reliable way to separate them.

What changes in your workup:
Consider sucrose malabsorption on the differential when a patient presents with chronic diarrhea and bloating and other substrates have already been ruled out.
Substrate-specific breath testing measures hydrogen and methane response to unmetabolized sucrose directly — providing objective data rather than another empiric elimination trial.
Both adult and pediatric patients can be tested, making sucrose malabsorption a workup option across your full patient population.

How CDI supports:
Hydrogen and methane breath testing for sucrose malabsorption → substrate-specific data before dietary restriction.
Non-invasive, at-home collection → accessible for pediatric and adult patients without a clinic visit.
Research-validated methodology → results that support evidence-based clinical decisions.

Full clinical overview here →
https://commdx.com/breath-testing-for-sucrose-malabsorption/

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