I just got a GI-MAP result back. One of the results is for high enterohemorrhagic ​Escherichia coli.​ I’m wondering if this is possibly a chronic condition. All the studies that I’ve found seem to indicate that this is a shorter self-limiting condition—a five-year-old, a history of prematurity, a mother with alcohol and marijuana use during pregnancy, and problems with constipation and encopresis. Any further insight about encopresis is helpful, as I have had people reach out to me lately with this condition.

There are kind of two questions here. One is about encopresis, which I agree is an incredibly difficult multifactorial [disorder], especially in pediatrics, and really, I don’t have a big pediatric practice and, this isn’t something that I’ve really looked into. I know that there are few specialists that I have referred out to. I want to say one was in Texas and these were more like just depending on where the patients were. I don’t have as much experience with encopresis.

In terms of the enterohemorrhagic ​E. coli, r​ emember what you’re looking at on the GI-MAP test is effectively kind of the DNA, so like what’s not necessarily, what’s active in a way, but what’s potentially present what’s there. And yes, I have interestingly seen enterohemorrhagic ​E. coli. I’ve seen ​Giardia​ also chronically coming up on both a Doctors Data stool test and a GI-MAP stool test, and ​Giardia​ is also supposed to be self-limiting, but I’ve seen it in patients where they say, “Yes, I had ​Giardia​ five years ago or six years ago.” And now they tend toward constipation. And so, I don’t know what—all the conventional kind of research, all the conventional information out there would say no, these are effectively self-limiting diarrheal illnesses. All I can say is that anecdotally, I have seen some of these “acute diarrheal illnesses” as kinds of chronic GI microbial imbalances. More often, I don’t know how to explain this, as they seem to be associated with constipation. I don’t know why that is. Again, ​Giardia​ is the one that I’ve seen a couple times in patients where they tend toward constipation. I do think it’s worth in general doing an antimicrobial protocol. In this case, if it’s just the enterohemorrhagic ​E. coli ​and it’s in a 5-year-old patient, I would do the pediatric antimicrobial protocol and I would see how the symptoms change. Completely understand the question there, like, is it possible to be a chronic condition? And based on the literature, it’s difficult to answer, but anecdotally, absolutely yes. I’m not entirely sure how; I don’t know if basically it is the acute illness that sort of runs its course and as you rebalance, like, the pathogenic microorganism kind of decreases in numbers and the beneficial bacteria rate, the probiotic, sort of outnumbers that one, so it suppresses the activity in a way. I don’t know. That’s how I’ve kind of come to think of it, and it’s still there in low levels, so it still has some pathogenicity. But again, that’s kind of more of how I’ve just put it together in my head.

Hopefully, that helps, and in terms of the encopresis, I’m sorry I don’t have more experience with that because I know it can really be a big problem.