GI Map

The GI-MAP test analyzes over 40 different commensal and pathogenic microorganisms, including bacteria, viruses, parasites, and fungi, along with markers of inflammation and digestive function. By identifying specific pathogens and imbalances in the gut microbiome, the GI-MAP offers valuable information for healthcare providers to develop personalized treatment plans tailored to the individual’s unique microbial profile. This stool test offers a non-invasive and comprehensive approach to evaluating gut health, providing actionable insights to optimize digestion, immune function, and overall well-being. With its ability to detect a wide range of gastrointestinal pathogens and dysbiosis,

the GI-MAP test serves as a valuable tool in the assessment and management of digestive disorders, allowing for targeted interventions to promote gut health and improve patient outcomes.

Who Can Benefit from a GI-MAP Comprehensive Stool Analysis Test?

The GI-MAP test, with its comprehensive analysis of gut health, is beneficial for a wide range of individuals from those looking to optimize their overall health to individuals who have been struggling with chronic illnesses with or without a clear diagnosis.
Here’s a breakdown of who can benefit from a GI-MAP test:

Individuals Seeking to Optimize Health: even in the absence of symptoms, the GI-MAP can offer insights into the gut microbiome’s health, providing an opportunity for preventative measures against potential health issues and supporting the body’s natural processes.

Patients with Chronic Digestive Dysfunction: for those who have suffered from chronic symptoms with or without a clear diagnosis, the GI-MAP can help identify underlying imbalances or infections in the gut that may be contributing to their health issues.

Autoimmune Diseases: since gut health is closely linked to the immune system, identifying and addressing gut dysbiosis can provide additional treatment options and provide crucial support in managing autoimmune conditions. [5., 20., 22.]

Gastrointestinal Disorders: for patients struggling with Small Intestinal Bowel Overgrowth (SIBO), Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD), the GI-MAP can identify specific pathogens, inflammatory markers, and digestive imbalances that may be contributing to symptoms like gas, bloating, diarrhea, and constipation. [20., 25.]

Digestive Complaints: people experiencing unexplained digestive issues such as gas, bloating, heartburn, indigestion, diarrhea, or constipation can identify potential causes and receive targeted treatment recommendations.

Neurological and Cognitive Issues: the vagus nerve is the primary nerve that innervates the digestive tract, and is considered the “highway of the gut-brain axis”. Insights into the gut-brain axis through the GI-MAP may reveal how gut health impacts an individual’s cognitive function and affects memory, concentration, and brain fog. [12.]

Skin Conditions: conditions like acne and psoriasis have been linked to gut health. Identifying and addressing gut dysbiosis can be a part of a comprehensive treatment plan to improve and restore skin health. [11.]

Mood Disorders: the gut-brain connection means that imbalances in gut microbiota can impact mood and emotional well-being, making the GI-MAP valuable for individuals with these conditions. [12., 21.]

Metabolic and Weight Issues: The GI-MAP can offer insights into the role of the gut microbiome in metabolism and weight regulation, providing avenues for intervention in diabetes management and weight loss. [3., 6.]

The GI-MAP test is a versatile tool that can benefit a broad spectrum of individuals by providing a detailed look at gut health and its impact on overall well-being. By identifying specific imbalances and pathogens, it allows for targeted interventions that can significantly improve a person’s quality of life, especially for those dealing with chronic and elusive health issues.

What is Included in the GI-MAP?

Microbial Flora Analysis

Pathogens: bacterial, parasitic and viral pathogens are known causes of intestinal gastroenteritis. The presence and amount of these pathogens are reported when found. It is important to note that some patients may test positive for these pathogens, yet be asymptomatic. It is possible for these pathogens to be present in the digestive tract but not actively produce virulence factors, which cause symptoms.

Specific Pathogens Reported on the GI Map are:

Bacterial Pathogens:

• Campylobacter
• C. difficile Toxin A
• C. difficile Toxin B
• Enterohemorrhagic E. coli
• E. coli O157
• Enteroinvasive E. coli/Shigella
• Enterotoxigenic E. coli LT/ST
• Shiga-like Toxin E. coli stx1
• Shiga-like Toxin E. coli stx2
• Salmonella
• Vibrio cholerae
• Yersinia enterocolitica

Parasitic Pathogens:

• Cryptosporidium
• Entamoeba histolytica
• Giardia

Viral Pathogens:

• Adenovirus 40/41
• Norovirus GI/II

H. Pylori: as with other gastrointestinal pathogens, it is possible to harborthe bacteria H. pylori and be asymptomatic. H. pylori typically invades the stomach or the duodenum. It is linked to ulcers, chronic gastritis, and stomach cancer, as well as causing initial low stomach acid followed by hyper aciduria, often leading to heartburn or GERD (gastrointestinal reflux disease). It may also be a culprit behind dyspepsia, abdominal pain, nausea, vomiting and chronic gastrointestinal symptoms.

By using DNA analysis for H. pylori virulence factors, the GI-MAP can represent the genetic potential for a particular H. pylori strain to cause pathology. This information, along with the patient’s personal and/or family history, may guide treatment decisions.

Beneficial Bacteria: these are labeled “Commensal/Keystone Bacteria” on the GI-MAP because of their positive benefits on human health. High levels of beneficial bacteria are generally good, indicating a healthy gut microbiome. These bacteria promote nutrient absorption from food, produce some vitamins (biotin and vitamin K), maintain a healthy mucosal lining, support detoxification, regulate immune function and inflammation at the gut lining, and protect against colonization from potential pathogens. [7.] Low levels might suggest a need for dietary changes, probiotics, or prebiotics.

Specific Commensal/Keystone Bacteria Reported on the GI-MAP Are:

• Bacteroides fragilis
• Bifidobacterium spp.
• Enterococcus spp.
• Escherichia spp.
• Lactobacillus spp.
• Enterobacter spp.
• Akkermansia muciniphila
• Faecalibacterium prausnitzii
• Roseburia spp.

The GI-MAP also reports the following bacterial phyla, or groups of bacteria, and their ratio:

• Bacteroidetes
• Firmicutes
• Firmicutes:Bacteroidetes Ratio

Bacteroidetes, a gram-negative group of bacteria, and Firmicutes, a gram-positive group of bacteria, constitute the two major groups of bacteria that are present in the human microbiome. An abnormal result in one or both of these phyla indicates an imbalance in the individual’s microbiome.

An increased Firmicutes:Bacteroidetes ratio indicates a microbial imbalance that has been implicated in increased caloric extraction from food causing weight gain and obesity; decreased insulin sensitivity; and increased inflammation. [14.]

A high Firmicutes:Bacteroidetes ratio may signal the need to make dietary improvements, provide digestive support, and individualized probiotic recommendations when taken into consideration with the rest of the findings of the GI-MAP.

Opportunistic Bacteria: These are not harmful in small amounts but can cause issues if overgrown, especially in immune compromised patients and/or in patients with leaky gut or impaired intestinal lining integrity. They have been known to cause symptoms in some people including diarrhea, loose stool, abdominal pain, and constipation, and some strains have been linked with autoimmune conditions. [5., 20.] High levels may indicate dysbiosis or an imbalance in the gut microbiota.

Specific Opportunistic Bacteria Reported on the GI-MAP Are:

Dysbiotic and overgrowth bacteria:

• Bacillus spp.
• Enterococcus faecalis
• Enterococcus faecium
• Morganella spp.
• Pseudomonas spp.
• Pseudomonas aeruginosa
• Staphylococcus spp.
• Staphylococcus aureus
• Streptococcus spp.

Commensal overgrowth microbes:

• Desulfovibrio spp.
• Methanobacteriaceae (family)

Inflammatory & autoimmune-related bacteria

• Citrobacter spp.
• Citrobacter freundii
• Klebsiella spp.
• Klebsiella pneumoniae
• M. avium subsp. paratuberculosis
• Proteus spp.
• Proteus mirabilis

Commensal inflammatory & autoimmune-related bacteria

• Enterobacter spp.
• Escherichia spp.
• Fusobacterium spp.
• Prevotella spp.

Fungi/Yeast: fungal organisms are a common component of the human microbiome, but overgrowth can cause problems, especially in the setting of leaky gut or an impaired intestinal lining. In patients who have positive findings for these organisms, additional testing including urinary D-arabinitol or Candida antibodies may be warranted.

Fungi/Yeast Reported on the GI-MAP Are:

• Candida spp.
• Candida albicans
• Geotrichum spp.
• Microsporidium spp.
• Rhodotorula spp.

Viruses: the presence of CMV (cytomegalovirus) and EBV (Epstein-Barr virus) in stool has been correlated with IBD. [8., 18.]. IBD patients infected with these viruses may be more susceptible to IBD flare ups with viral reactivations. [16.] A positive finding on the GI-MAP indicates current infection.

Viruses Reported on the GI-MAP Are:

• CMV, Cytomegalovirus
• EBS, Epstein-Barr Virus

Parasites: parasites are organisms that feed on the host organism, at its expense. The GI-MAP tests for pathogenic and non-pathogenic parasites.

Parasites Reported on the GI-MAP Are:

Protozoa

• Blastocystis hominis
• Chilomastix mesnili
• Cyclospora spp.
• Dientamoeba fragilis
• Endolimax nana
• Entamoeba coli
• Pentatrichomonas hominis

Worms

• Ancylostoma duodenale
• Ascaris lumbricoides
• Necator americanus
• Trichuris trichiura
• Taenia spp.

Digestive Markers

Elastase: Elastase 1 is a digestive enzyme produced exclusively by the pancreas, making it an effective indirect marker of pancreatic function. Elastase levels are not affected by the use of supplemental digestive enzymes. Elastase helps break down proteins. Low levels can indicate pancreatic insufficiency.

Steatocrit: Steatocrit is fecal fat. Normally, dietary fat in the small intestine is emulsified by bile acids and absorbed. High levels suggest fat maldigestion and/or malabsorption, which can be due to various digestive disorders.

Inflammatory and Immune Markers Calprotectin: considered the “gold standard” marker of inflammation in the GI tract. High levels can indicate inflammatory bowel diseases (IBD) such as Crohn’s disease or ulcerative colitis, and is used to distinguish IBD from irritable bowel syndrome, IBS, in which no pathological process can be determined; instead, IBS is considered a functional diagnosis.

Secretory IgA (sIgA): the primary immunoglobulin at the digestive system border, sIgA is an immune marker that plays a critical role in mucosal immunity. Levels can provide insight into the immune system’s status in the gut, with elevated levels indicating an acute infection and/or chronic dysbiosis, food sensitivities, or acute stress. Low levels may be caused by chronic stress, immune compromise, and again, chronic dysbiosis.

Anti-Gliadin SIgA: gliadin is a component of gluten, which can stimulate inflammation in the digestive tract of susceptible individuals. It may indicate an immune response to gluten in the digestive tract, although this does not necessarily correlate with blood levels.

Eosinophil Activation Protein (EDN/EPX): eosinophils are white blood cells normally present in the gut that support immunity and maintain the protective mucosal barrier of the gut lining. [15.] The Eosinophil Activation Protein is secreted by eosinophils in response to infections (particularly viral infections), allergic and inflammatory responses. [1.]

Additional Markers

Occult Blood: The presence of blood in the stool that is not visible to the eye can indicate bleeding in the GI tract.

Beta-Glucuronidase: high levels of beta-glucuronidase in the stool indicates dysbiosis, and it may also point to detoxification issues at the liver, specifically with the glucuronidation step of phase II liver detoxification. Rising levels of Beta-GLucuronidase have also been correlated with impaired estrogen metabolism and increased risk of estrogen-induced diseases. [13.]

Antibiotic Resistance Genes: Detection of these genes can help guide treatment decisions, specifically whether antibiotic therapy is warranted in a particular case, and which antibiotics may not be effective against certain bacteria.

Preparation & Timing

Patients can continue taking all medications unless otherwise directed by their provider. The test can be taken at any time without specific timing requirements.

Collection Instructions:

• Patients must write their full name, date of birth, and date of collection on the specimen vial.
• They should collect stool into the provided collection tray, ensuring the specimen vial is filled to the indicated “fill line” after adding stool from multiple areas.
• The specimen vial should be tightly capped, vigorously shaken, and placed into the specimen bag along with the absorbent pad before sealing the bag and placing it into the kit box.
• The completed test requisition form with personal and sample collection information should be placed into the kit box.

Shipping:

• Samples must be received by the lab within 5 days of collection and are only viable for 10 days post-collection.
• If the sample cannot be shipped on the day of collection, it should be refrigerated (not frozen) and shipped within 3 days.
• The sample, along with the completed test requisition form, should be placed into the provided FedEx Clinical Pak Mailer for shipping.

Results:

• Results are typically released to the provider 5-10 business days after the sample is received at the lab, with no guaranteed processing time.
• The provider will notify the patient when the results are available and schedule a follow-up
  appointment for review.