Tests for Gut Health

Introduction

Many people experience digestive symptoms throughout their day. These may include bloating, gas, reflux, diarrhea, constipation, pain in the abdomen, and more. These symptoms could simply mean that someone ate something that didn't agree with them, or maybe they are more stressed than normal. Experiencing these symptoms more often than not is not normal. Schedule an appointment with a doctor and a dietitian to identify what's going on and begin the path to health.

Symptoms like these can arise from food sensitivities, celiac disease, pancreatic enzyme insufficiency, inflammation, diverticulitis, stress, working out too much, and the list goes on. More often than not, it’s hard to pinpoint a cause, and that’s where additional testing comes in.

Believe it or not, there are more than 20 digestive diagnostic procedures a doctor can perform to help them diagnose a digestive condition. They include blood tests, imaging, endoscopic procedures, stool testing and more. A medical doctor will decide which testing is best by taking an in-depth health history and possibly performing a physical exam.

In addition to scheduling an appointment with a doctor, schedule one with a Registered Dietitian. They can not only guide patients in what testing might be best, they can review food diaries, lifestyle, and labs in order to determine what might be contributing to symptoms and make recommendations for how relief can be achieved.

What’s not included in this article is the many tests that can be purchased from third party companies online. These include at home food sensitivity testing, microbiome testing, and more and are not necessarily something we recommend at Cascade Wellness. Most of them have not gone through robust validation studies making the results questionable.

Continue reading below to get a better understanding of a handful of the testing that can be done for gut health. Keep in mind this is not a comprehensive list and only meant to introduce the types of tests that a doctor or dietitian might recommend.

A few tests

Blood Tests:

• CMP with CBC with Differential (Comprehensive Metabolic Panel with Complete Blood Count with Differential): a doctor may start with this simple and standard blood test to check to see if anything is amiss. The CBC with Differential part looks at white blood cells (and the amount of each type of white blood cells), red blood cells, platelets, hemoglobin, hematocrit, and mean corpuscular volume. The CMP part measures 14 different substances in the body including glucose, albumin, calcium, electrolytes, liver enzymes, bilirubin, blood urea nitrogen, and creatinine. This test can help to identify any number of health conditions from anemia to infection, and may help the point towards other tests that would be good to run.

• Celiac blood test: a blood test to diagnose Celiac disease. This is called “tTG-IgA”. The genetic testing would be something called “HLA-DQ2” and “HLA-DQ8” which would show if the gene for celiac disease is present or not. Sometimes a physician may order this test to see if it’s something that should be monitored in your blood relatives as well. It’s important to note that the range of symptoms with celiac can vary significantly meaning that someone who experiences no symptoms when they eat gluten may actually test positive for the disease.

Stool Lab Tests:

• Stool culture: this is a test that looks for the presence of abnormal types and amounts of bacteria in the digestive tract. Most people will have E. coli in their stool and this test can show if the amount of that bacteria, or another unwanted bacterium, is higher than normal. This test is done by collecting a small amount of stool and taking it to a lab. Results are usually back in a few days.

• Stool elastase: this test measures the amount of the enzyme elastase in the stool. Elastase is an enzyme made by the pancreas and helps to break down fat, carbohydrates, and protein, and it plays a key role in the digestive process. If phlegm or mucus is present in the stool, it may be a sign that the elastase enzyme isn’t working as well as it should, which can contribute to many different gastrointestinal symptoms. A stool elastase test may be a good next step.

Breath Test:

• Hydrogen Breath Test: this test consists of drinking a beverage containing a substrate (usually a mixture of water and lactulose, or glucose), and then measuring the amount of hydrogen or methane that is breathed out. A rapid rise in the amount of hydrogen or methane may indicate an overgrowth of unwanted bacteria in the small intestine. This is also known as SIBO or Small Intestinal Bacterial Overgrowth. This may also be a cause of unwanted GI symptoms. Be aware however that this test is not considered as specific as other tests that can be done to look for bacterial overgrowth. While widely available and considered less invasive, the breath test may be the place a doctor starts before doing an endoscopy procedure.

Endoscopic Procedures:

• Colonoscopy: a procedure that allows a doctor to view the entire Colon. It can help to identify inflammation, abnormal growths, ulcers, and bleeding. They may also take samples of the colon for additional testing. Usually, insurance doesn’t cover a colonoscopy until the age of 45, unless unusual GI symptoms are present.

• Endoscopy: a procedure that allows a doctor to view the esophagus, stomach, and duodenum (upper part of the small intestine). Via this test the doctor can identify structural abnormalities, inflammation, take samples for additional testing, and more.

Other:

• Hypochlorhydria: this weird word means low stomach acid, specifically hydrochloric acid (HCL). HCL plays an essential role in the digestive process, helping to break down nutrients prior to them entering the small intestine. If nutrients enter the small intestine prior to initial digestion, this can cause unwanted GI symptoms, and is one of the contributors to SIBO. In addition, inadequate HCL can lead to vitamin and nutrient deficiencies which can increase susceptibility to infections that may cause further GI distress. It can be a vicious circle. There are several different tests a doctor’s office may do to understand if there is not enough stomach acid present. A simple one can be done at home. Ask your doctor or dietitian if this test is right for you.

Summary

These are only a few of the tests that can be performed to identify digestive diseases; there are many more that are not included here. If you have unwanted GI symptoms more often than not, schedule an appointment with your doctor as soon as possible. If it’s with your primary care physician, they may refer you to a gastroenterologist for more specialized care. Also, schedule an appointment with a dietitian so you can get an expert's view of your diet and lifestyle, to understand what changes may help to alleviate your symptoms, while you wait for testing to be completed.

References

Cleveland Clinic. (2022, June 27). Hypochlorhydria. Retrieved from https://my.clevelandclinic.org/health/diseases/23392-hypochlorhydria

Johns Hopkins Medicine. (n.d.). Digestive Diagnostic Procedures. Retrieved from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/digestive-diagnostic-procedures

Mayo Clinic. (2022, January 6). Small Intestinal Bacterial Overgrowth (SIBO). Retrieved from https://www.mayoclinic.org/diseases-conditions/small-intestinal-bacterial-overgrowth/diagnosis-treatment/drc-20370172

National Institutes for Health, National Library of Medicine, Medline Plus. (2022, April 4). Complete Blood Count (CBC). Retrieved from https://medlineplus.gov/lab-tests/complete-blood-count-cbc/

National Institutes for Health, National Library of Medicine, Medline Plus. (2021, September 9). Comprehensive Metabolic Panel (CMP). Retrieved from https://medlineplus.gov/lab-tests/comprehensive-metabolic-panel-cmp/

National Institute for Health, National Library of Medicine, Medline Plus. (2021, March 8). Stool Elastase. Retrieved from https://medlineplus.gov/lab-tests/stool-elastase/