As a naturopathic doctor who specializes in the treatment of complex gastrointestinal conditions, I see more than my fair share of difficult-to-diagnose and difficult-to-treat patients. Sometimes it is possible with a thorough history to deduce what is likely going on underneath, and other times a patient shares a plethora of symptoms that can be attributed to many different disease processes. This is when further testing is needed.
While visiting a gastroenterologist and getting routine examinations like an upper endoscopy and colonoscopy are often necessary in cases like these, when these tests are normal, many patients are left without any explanation for their symptoms. This means they also often leave without any treatment plan. They are disheartened, thinking, “nothing is wrong with me, but I somehow still have all these symptoms and I guess nothing can be done”. But this is often very far from the truth.
As I often tell my patients, a negative test result only means we have ruled out whatever was specifically tested for. And each individual test is only able to rule out a certain amount of conditions. In the world of gastroenterology, there are literally hundreds of tests that would need to be run if we wanted to rule out EVERY potential cause of GI symptoms. This is where working with a skilled physician who knows the right tests to order based on your symptoms and history is extremely important.
Circling back to the topic of complex patients, many times what is most indicated for them is a wide-reaching test that evaluates for a very large number of underlying conditions. By doing this, we are #1- able to see if there are multiple issues going on at the same time (spoiler alert—in complex patients there usually are!), and #2- able to diagnose more rare diseases when the common ones have already been ruled out.
The test I use most often in this case is Genova’s GI Effects Comprehensive Panel. This is a stool test kit that patients take home and send back out in the mail after they have collected their samples. Here is the breakdown of all the tests that this kit includes:
Digestion/Absorption Tests:
- Pancreatic Elastase-1 is a marker of exocrine pancreatic function. If this level is low, patients often have trouble completely breaking down their food.
- Products of Protein Breakdown are markers of undigested protein reaching the colon.
- Fecal Fat is a marker of fat in this stool. If this is elevated, then we know that patients are not breaking down fats effectively.
Inflammation/Immunology Tests:
- 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 (ulcerative colitis and Chron’s Disease) and Irritable Bowel Syndrome (IBS).
- 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 Tests:
- Genova is the first laboratory to introduce an Inflammation-Associated Dysbiosis score and a Methane Dysbiosis score by incorporating the latest, published microbiome data analysis.
- 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, abundance and patterns of gut organisms.
- Bacterial and mycology cultures demonstrate the presence of specific beneficial and pathogenic 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.
Additional Add-On Biomarkers Available:
- Campylobacter
- Clostridium difficile
- Escherichia coli
- Helicobacter pylori
- Fecal Lactoferrin
- Macroscopic Exam for Worms
- Zonulin Family Peptide
- KOH Preparation for Yeast
While this amount of detailed and “scientific-sounding” information may be overwhelming to some patients, physicians who are trained in this area of medicine can often use the information gathered to create very accurate and detailed treatment plans. Often, we find missing pieces that were missed by other doctors that are crucial in creating good outcomes. As with any condition, the key to an effective treatment plan is to find and treat the cause, and for complex patientsthis often means digging deeper to make sure we find it.
Dr. Katie Nuckolls is a naturopathic physician and owner of Thrive GI: Natural Digestive Medicine in Vancouver, Washington. She currently sees patients that live in Washington and Oregon using a combination of telemedicine and in-office visits. For more information, visit our contact page or schedule a free 15-minute consultation online.