Justin asks, “GI Map is currently the stool test of choice?”
Chris: I’m not quite ready to say that yet. It looks promising, but I don’t like to make those kinds of recommendations until I’ve had the chance to really put it through the paces myself, test it with patients, look at testing, treatment and then retesting to see if there’s consistency and the results make sense. We do some split samples where we send the same stool sample in two different containers to the lab on the same day to try to make sure that the results are consistent. This is just what I do when I come across a new test that I’m interested in, so that’s going to take a little while to do, but I find it I think it’s very promising. They have their report on all the bacterial pathogens, parasites, including Cyclospora and some of the pathogens which are becoming of increasing concern. They even report on adenovirus and Norovirus, which are viral pathogens, H. pylori quantification, and virulence factors. They report on the normal bacterial flora, so Lactobacillus, Bifidobacteria, Bacteroides, Enterococcus, E. coli, and so on. They also do some opportunistic bacteria, some autoimmune triggers like Citrobacter, Klebsiella, MAP which is M avium subspecies paratuberculosis, which some researchers and doctors think is a trigger for IBD and Crohn’s disease. They do fungi. They actually even do Cytomegalovirus and Epstein-Barr in the stool, some of the worms like hookworm, whipworm, and roundworm, and then they started to add more digestive markers like elastase. They’ve got calprotectin. I’m hoping they’ll add lysozyme and lactoferrin soon, which would then really get to the point of not needing to do the Doctors’ Data comprehensive. They’ve got beta-glucuronidase. They have zonulin, but I’m not sure yet about fecal zonulin. I need to look into it more and see what the accuracy of that. They have antibiotic resistance genes, which can be helpful. They will report on beta-lactamase, fluoroquinolones, macrolides, vancomycin, and then some of the drugs for the H. pylori protocol that are typically used, not in our protocol, but in the conventional protocol if H. pylori is positive, so clarithromycin and again the fluoroquinolones, tetracycline, and amoxicillin.