GI Testing: Where Do I Begin?
GI Testing: Where Do I Begin?
A closer look at three of the most clinically useful GI tests Colabs offers: the GI-MAP, SIBO Breath Test and the IBS Smart.
The gut is possibly the most important regulator of our health, with the microbiome being considered by some so important that it should be considered an organ in its own right. Gut health certainly plays a role in the pathogenesis of numerous diseases and contributes to a wide array of symptoms, so it is no surprise that gastrointestinal (GI) tests are widely popular, especially in the field of functional medicine.
With so many test options available, it can be difficult to know where to start. For example, a stool test could be considered, such as the GI Map, or you could consider going straight to something with a narrower focus, such as the SIBO breath test. Perhaps you might want to consider testing for autoimmune mechanisms in the gut? We’ll take a look at 3 types of GI tests - the GI Map, the SIBO breath test, and the IBS Smart test, some of the benefits these tests can offer, and what sort of clinical scenarios may call for these tests.
The 3 Key GI Test For Your Clinical Practice
- The GI-MAP
The GI Map offers a view of the microbiome environment, paying particular attention to microbes that may be disturbing normal microbial balance and may contribute to dysbiosis or illness.
The panel is a comprehensive collection of microbial targets as well as immune and digestive markers.
It screens for pathogenic bacteria, commensal bacteria, opportunistic pathogens, fungi, viruses, and parasites.
Some other useful features of this the GI Map include its analysis of H.Pylori and the Zonulin add-on. The test analyses H.Pylori and its virulence factors which can may indicate a potentially greater level of risk associated with infection. Zonulin, a protein that increases intestinal permeability, is available as an add-on, and is a useful marker for assessing the potential need for intestinal barrier support. When Zonulin levels go up, there may be an increased risk of excessive intestinal permeability, known colloquially as ‘leaky gut’.
A strength of the GI Map compared to other stool tests is that it uses qPCR technology which is a more sensitive and specific methodology than culturing, thereby reducing the likelihood of missing pathogens that don’t grow well in laboratory conditions. The GI Map also provides practitioners with quantitative information about pathogens, which is useful in supporting clinical decision-making. The absolute amount of the organism can be useful to know - a relatively low level of a pathogen may require a less intensive approach to treatment, and certain opportunistic bacteria are only considered pathogenic at certain levels. Additionally, it can be incredibly useful to see if the severity of symptoms matches a particular test result when considering clients symptoms.
- SIBO Breath Test
Although the classic definition of SIBO refers to the overgrowth of commensal organisms, opportunistic and pathogenic organisms are often involved and motility changes are implied. For this reason, it’s advisable to do broader testing such as the GI-MAP to elucidate the bigger picture. Test results from the GI-MAP may indicate possible SIBO, so we can look to signs of fat malabsorption and elevated levels of several species of opportunistic pathogens on the GI Map for clues that SIBO testing can be considered. Though the GI-MAP is not considered a conclusive test for SIBO, it may hint at a need for further investigation.
Understanding whether methane or hydrogen gases are predominant can be useful and help build a body of evidence alongside symptoms that help the direction of therapeutic interventions. In cases of SIBO, constipation links more frequently to higher methane levels, and a looser stool presentation tends to correlate more frequently with higher hydrogen levels.
SIBO can develop in a number of patient populations, including those with thyroid disorders, IBS, IBD, Coeliac Disease, Diabetes, Obesity, and Parkinson’s. It is also commonly associated with the use of certain medications, including antibiotics and PPI’s. Typical symptoms may include nausea, bloating, vomiting, diarrhoea, weight loss and malabsorption.
Colab’s SIBO breath kits come with either Glucose or Lactulose as a substrate. Glucose is most useful for distal SIBO and lactulose for proximal SIBO. We recommend starting with Lactulose if this is the first time the test has been undertaken, as Glucose may fail to identify distal SIBO due to its rapid absorption in the proximal small intestine.
- IBS Smart
Recently, biomarkers for IBS (anti-CdtB and anti-vinculin)have been identified that are measurable in a patient's blood. While these biomarkers do not indicate all forms of IBS, they are associated with IBS-D (diarrhoea-predominant)and IBS-M (diarrhoea and constipation mixed) cases. The IBS Smart has changed the diagnostic landscape for IBS patients. IBS used to be a diagnosis of exclusion, but this test allows us to arrive at a diagnosis more quickly and cost-effectively. For non-medical practitioners it can still be incredibly useful for indicating an autoimmune trend in the gut lining, although it is still important to consider that other diagnostic tests may still be required by medical practitioners to rule out other more significant pathology.
The IBS Smart is useful in clinical scenarios where IBS symptoms have begun after food poisoning. Post-infectious IBS can be a result of autoimmunity that is triggered by bacterial, viral or parasitic infection of the GI tract, which can lead to changes in the gut mucosa, gut motility and absorptive capacity of the gut.
GI testing is useful not only for persistent or distressing gastrointestinal symptoms but can be considered in cases where there are only mild GI symptoms accompanied by non-GI symptoms including brain fog, depression and fatigue, all of which may be systemic indicators of gastrointestinal disruption.
If you’d like more advice on choosing the right test, we’re happy to assist. Please contact us to book a free support call.
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