GI Testing

When Should the GI Effects Comprehensive Stool Profile Be Considered?

The GI Effects Comprehensive Stool Profile can reveal important information about the root cause of many common gastrointestinal symptoms such as gas, bloating, indigestion, abdominal pain, diarrhea, and constipation. This stool analysis utilizes biomarkers such as fecal calprotectin to differentiate between Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS).^4,5 In addition, Genova's GI Effects test can be used to evaluate patients with a clinical history that suggests a gastrointestinal infection or dysbiosis.

Gut microbes are codependent with one another and with their human host, and the health of one affects the other. A sizeable volume of research associates a dysbiotic, or imbalanced gut microbiome with multiple disease states both within and outside of the GI tract.^2,3 The diverse metabolic activities of the microbiome ultimately impact the human host, and the activities of the human host ultimately affect the health of their microbiome.

The GI Effects Comprehensive Stool Profile Biomarkers

The biomarkers on the GI Effects Comprehensive Profile reflect the 3 key functions of gut health arranged in the "DIG" format: Digestion/Absorption, Inflammation/Immunology, and the Gut Microbiome:

• Digestion/Absorption:
  • Pancreatic Elastase-1 is a marker of exocrine pancreatic function.
  • Products of Protein Breakdown are markers of undigested protein reaching the colon.
  • Fecal Fat is a marker of fat breakdown and absorption.

• Inflammation/Immunology:
  • Calprotectin is a marker of neutrophil-driven inflammation. Produced in abundance at sites of inflammation, this biomarker has been proven clinically useful in differentiating between Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS).^4,5
  • Eosinophil Protein X is a marker of eosinophil-driven inflammation and allergic response.
  • Fecal Secretory IgA is a marker of gut secretory immunity and barrier function.
  • Fecal Occult Blood Test detects hidden blood; fecal immunochemical testing (FIT) has been recommended by the American College of Gastroenterology as the preferred noninvasive test for colorectal cancer screening/detection.

• Gut Microbiome:
  • Metabolic indicators, including short-chain fatty acids and beta-glucuronidase, demonstrate specific and vital metabolic functions performed by the microbiota.
  • Commensal Bacteria demonstrate the composition and relative abundance of gut organisms.
    • More than 95% of commensal gut organisms are anaerobic and are difficult to recover by traditional (aerobic) culture techniques.
    • GI Effects assesses a set of 24 genera/species that map to 7 major phyla.
  • Bacterial and mycology cultures demonstrate the presence of specific beneficial and pathological organisms.
  • Bacterial and mycology sensitivities are provided for pathogenic or potentially pathogenic organisms that have been cultured. The report includes effective prescriptive and natural agents.
  • Parasitology includes comprehensive testing for all parasites on every parasitology exam ordered.
    • GI Effects provides microscopic fecal specimen examination for ova and parasites (O&P), the gold standard of diagnosis for many parasites.
    • 6 Polymerase chain reaction (PCR) targets detect common protozoan parasites including Blastocystis spp. with reflex subtyping 1-9, Cryptosporidium parvum/hominis, Cyclospora cayetanensis, Dientamoeba fragilis, Entamoeba histolytica, and Giardia. PCR for organisms is emerging as a highly sensitive method for infectious organism detection.
    • Selection of a one-day or three-day sample collection is based on the clinician's clinical index of suspicion for parasitic infection. If there is no/low suspicion, a one-day sample will likely be adequate. For high suspicion, a three-day sample collection is optimal.

• Additional Biomarkers Available:
  • Campylobacter
  • Clostridium difficile
  • Escherichia coli
  • Fecal Lactoferrin
  • Helicobacter pylori
  • Macro Exam for Worms
  • Zonulin Family Peptide
  • KOH Preparation for Yeast

What Advantage Does the Profile Offer Compared to Other Diagnostics?

A structured fecal biomarker panel offers the advantage of assessing multiple functional areas that may be contributing to symptoms. For example, diarrhea could stem from multiple causes including pancreatic exocrine insufficiency, inflammation, food allergies, or the presence of a pathogenic or potentially pathogenic organism. A positive result on one or more fecal biomarker tests may guide therapy, either by suggesting a treatable alternative diagnosis or by eliminating a diagnosis from further consideration. The latter allows individualized targeted treatment to be redirected to more likely diagnoses.^6,7

GI Effects® represents the best technical platform available to assess the gut microbiome, combining:

• 16S rRNA gene polymerase chain reaction (PCR) amplification technique for anaerobic commensal bacteria
• Matrix Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) technology for limitless bacterial and fungal species identification via culture
• Gold standard microscopic ova and parasite (O&P) detection
• Real-time PCR for the identification of 6 common parasites
• Next-Generation DNA sequencing for Blastocystis spp. with reflex subtyping 1-9

The test report findings are synthesized into a results overview that helps the clinician to prioritize findings with functional imbalance scores and therapeutic support options. Furthermore, Genova summarizes the status of the patient's commensal bacteria levels with clinically actionable data.

What Can Clinicians and Patients Expect from GI Effects Comprehensive Profile Stool Testing?

The GI Effects Stool Profile biomarkers provide comprehensive information for the development of strategic interventions. Symptoms often improve as identified functional imbalances and inadequacies become normalized through targeted dietary, lifestyle, and supplementation therapeutics.

References

1. Chen L, et. al. Development of an Index Score for Intestinal Inflammation-Associated Dysbiosis Using Real-World Stool Test Results. Dig Dis Sci. 2019.
2. Marchesi J, et. al. The gut microbiota and host health: a new clinical frontier. Gut. 2016 Feb;65(2):330-9.
3. Clemente J, et. al. The impact of the gut microbiota on human health: an integrative review. Cell. 2012 Mar;148(6):1258-70.
4. Menees SB, et. al. A meta-analysis of the utility of C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and fecal lactoferrin to exclude inflammatory bowel disease in adults with IBS. Am J Gastroenterol. 2015 Mar;110(3):444-54.
5. Dabritz J, Musci J, Foell D. Diagnostic utility of faecal biomarkers in patients with irritable bowel syndrome. World J Gastroenterol. 2014 Jan;20(2):363-375.
6. Parsons K, et. al. Novel testing enhances irritable bowel syndrome medical management: the IMMINENT study. Glob Adv Health Med. 2014 May;3(3):25-32.
7. Goepp J, et. al. Frequency of abnormal fecal biomarkers in irritable bowel syndrome. Glob Adv Health Med. 2014 May;3(3):9-15.