The GI-MAP (Gastrointestinal Microbial Assay Plus) test, offered by Diagnostic Solutions Laboratory, is a comprehensive stool test designed to assess the microbiome and detect gastrointestinal pathogens.
Utilizing advanced DNA sequencing technology, the GI-MAP provides detailed insights into the presence and levels of gut bacteria, viruses, parasites, and fungi, allowing for targeted interventions to restore gut health.
This test also offers a comprehensive assessment of gastrointestinal function, to aid in assessment and management of various digestive disorders including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and gastrointestinal infections. [20.]
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.
If you want to order the Zonulin add-on, please order the "GI-MAP + Zonulin" test. The GI-MAP measures a variety of gastrointestinal microbiota DNA using qPCR technology. It detects microbial imbalance, microbes contributing to illness, and indicators of digestion, absorption, inflammation, and immune function. Due to a supply shortage, this test no longer includes antibiotic resistance genes to opportunistic/universal bacteria.
The GI-MAP® from Diagnostic Solutions Laboratory is a comprehensive stool analysis that measures gastrointestinal microbiota DNA from a single stool sample. Using state-of-the-art, quantitative polymerase chain reaction (qPCR) technology, the GI-MAP evaluates gut pathogens, bacterial infections, yeast overgrowth, viruses, and parasites. Antibiotic resistance genes and virulence factors are also included on the test for unparalleled insight into H. pylori.
Recently, the GI-MAP has been enhanced to include an upgraded report with visual cues that allow for easier readability. Further, additional markers, including Roseburia spp., Desulfovibrio spp., and Eosinophil Activation Protein (EPX/EDN), have been added to include even greater insight into patient health.
The GI-MAP was designed to detect microbes that may be disturbing normal microbial balance or contributing to illness. To complete the picture of overall health, the GI-MAP includes key markers related to digestion, absorption, inflammation, and immune function.
An unhealthy gut can cause uncomfortable symptoms that are felt beyond the gastrointestinal (GI) tract. In fact, the root cause of brain fog, fatigue, headaches, food sensitivities, and more can often be traced back to the gut.
The GI-MAP offers impactful, quantitative results that enable practitioners to create personalized protocols that address the underlying cause(s) of uncomfortable symptoms for even the most complex patients.
qPCR offers a much more accurate way to detect and quantify clinically-relevant organisms than standard PCR, culture, microscopy, or DNA sequencing-based methods. Accurately assessing how much
of an organism's DNA is present in a patient's stool sample is essential for helping practitioners to determine the clinical significance of pathogenic organisms and dysbiosis patterns.
The GI-MAP allows practitioners to create personalized treatment protocols to address gut dysfunction based on which infections are urgent, which areas of the gut are already optimized, and which areas should be addressed after an infection is resolved.
Additionally, the quantification offers a remarkable ability to see how treatment modalities are working because a retest after treatment can show whether a parasite has resolved, dysbiosis has improved, and more.
The GI-MAP Test by Diagnostic Solutions Laboratory is a comprehensive stool test that uses quantitative PCR technology to detect bacteria, parasites, fungi, viruses, and more within the gastrointestinal tract. The test is designed to provide insight into the microbiome's composition, the presence of pathogenic microorganisms, and other important markers of gastrointestinal health. Here's a summary of what the GI-MAP can show:
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:
Parasitic Pathogens:
Viral Pathogens:
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 hyperaciduria, 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. [2.,4., 9., 10., 17., 18., 24.
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:
The GI-MAP also reports the following bacterial phyla, or groups of bacteria, and their 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:
Commensal overgrowth microbes:
Inflammatory & autoimmune-related bacteria
Commensal inflammatory & autoimmune-related bacteria
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:
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:
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
Worms
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.
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 (particilularly viral infections), allergic and inflammatory responses. [1.]
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.
Zonulin is available as an add-on marker on the GI-MAP. Adding a Zonulin test enhances the comprehensiveness of the GI-MAP by providing additional information about gut health beyond microbial composition.
Zonulin is a protein involved in modulating the tight junctions between epithelial cells in the intestines. Elevated levels of zonulin can indicate increased intestinal permeability, often referred to as "leaky gut syndrome." Incorporating a Zonulin test alongside the GI-MAP allows clinicians to assess the integrity of the intestinal barrier, providing insights into gastrointestinal health and potential underlying conditions such as inflammatory bowel disease, celiac disease, and autoimmune disorders.
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.
The Rupa test requires printing the requisition form from the patient portal and sending it back with the samples.
No special preparation or timing is needed for the test.
Samples must be received by the lab within 5 days of collection and are only viable for 10 days post-collection.
The sample is shipped in a provided, prepaid FedEx Clinical Pak Mailer and can only be shipped Monday through Friday.
Patients can continue taking all medications unless otherwise directed by their provider.
The test can be taken at any time without specific timing requirements.
References
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[2.] Ansari S, Yamaoka Y. Helicobacter pylori BabA in adaptation for gastric colonization. World J Gastroenterol. 2017 Jun 21;23(23):4158-4169. doi: 10.3748/wjg.v23.i23.4158. PMID: 28694656; PMCID: PMC5483490.
[3.] Aoun A, Darwish F, Hamod N. The Influence of the Gut Microbiome on Obesity in Adults and the Role of Probiotics, Prebiotics, and Synbiotics for Weight Loss. Prev Nutr Food Sci. 2020 Jun 30;25(2):113-123. doi: 10.3746/pnf.2020.25.2.113. PMID: 32676461; PMCID: PMC7333005.
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[5.] Brady DM. Molecular Mimicry, the Hygiene Hypothesis, Stealth Infections and Other Examples of Disconnect between Medical Research and the Practice of Clinical Medicine in Autoimmune Disease. Open Journal of Rheumatology and Autoimmune Diseases. 2013;03(01):33-39. doi:https://doi.org/10.4236/ojra.2013.31007
[6.] Breton J, Galmiche M, Déchelotte P. Dysbiotic Gut Bacteria in Obesity: An Overview of the Metabolic Mechanisms and Therapeutic Perspectives of Next-Generation Probiotics. Microorganisms. 2022 Feb 16;10(2):452. doi: 10.3390/microorganisms10020452. PMID: 35208906; PMCID: PMC8877435.
[7.] Bull MJ, Plummer NT. Part 1: The Human Gut Microbiome in Health and Disease. Integr Med (Encinitas). 2014 Dec;13(6):17-22. PMID: 26770121; PMCID: PMC4566439.
[8.] Ciccocioppo R, Racca F, Paolucci S, Campanini G, Pozzi L, Betti E, Riboni R, Vanoli A, Baldanti F, Corazza GR. Human cytomegalovirus and Epstein-Barr virus infection in inflammatory bowel disease: need for mucosal viral load measurement. World J Gastroenterol. 2015 Feb 14;21(6):1915-26. doi: 10.3748/wjg.v21.i6.1915. PMID: 25684960; PMCID: PMC4323471.
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[10.] Dabiri H, Jafari F, Baghaei K, Shokrzadeh L, Abdi S, Pourhoseingholi MA, Mohammadzadeh A. Prevalence of Helicobacter pylori vacA, cagA, cagE, oipA, iceA, babA2 and babB genotypes in Iranian dyspeptic patients. Microb Pathog. 2017 Apr;105:226-230. doi: 10.1016/j.micpath.2017.02.018. Epub 2017 Feb 20. PMID: 28215588.
[11.] De Pessemier B, Grine L, Debaere M, Maes A, Paetzold B, Callewaert C. Gut-Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions. Microorganisms. 2021 Feb 11;9(2):353. doi: 10.3390/microorganisms9020353. PMID: 33670115; PMCID: PMC7916842.
[12.] Han Y, Wang B, Gao H, He C, Hua R, Liang C, Zhang S, Wang Y, Xin S, Xu J. Vagus Nerve and Underlying Impact on the Gut Microbiota-Brain Axis in Behavior and Neurodegenerative Diseases. J Inflamm Res. 2022 Nov 9;15:6213-6230. doi: 10.2147/JIR.S384949. PMID: 36386584; PMCID: PMC9656367.
[13.] Hu S, Ding Q, Zhang W, Kang M, Ma J, Zhao L. Gut microbial beta-glucuronidase: a vital regulator in female estrogen metabolism. Gut Microbes. 2023 Jan-Dec;15(1):2236749. doi: 10.1080/19490976.2023.2236749. PMID: 37559394; PMCID: PMC10416750.
[14.] Lee Y, Lee HY. Revisiting the Bacterial Phylum Composition in Metabolic Diseases Focused on Host Energy Metabolism. Diabetes Metab J. 2020 Oct;44(5):658-667. doi: 10.4093/dmj.2019.0220. Epub 2020 Jul 9. PMID: 32662252; PMCID: PMC7643595.
[15.] Loktionov A. Eosinophils in the gastrointestinal tract and their role in the pathogenesis of major colorectal disorders. World J Gastroenterol. 2019 Jul 21;25(27):3503-3526. doi: 10.3748/wjg.v25.i27.3503. PMID: 31367153; PMCID: PMC6658389.
[16.] Matsumoto H, Kimura Y, Murao T, et al. Severe Colitis Associated with both Epstein-Barr Virus and Cytomegalovirus Reactivation in a Patient with Severe Aplastic Anemia. Case Reports in Gastroenterology. 2014;8(2):240-244. doi:https://doi.org/10.1159/000365546
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[22.] Scher JU, Sczesnak A, Longman RS, Segata N, Ubeda C, Bielski C, Rostron T, Cerundolo V, Pamer EG, Abramson SB, Huttenhower C, Littman DR. Expansion of intestinal Prevotella copri correlates with enhanced susceptibility to arthritis. Elife. 2013 Nov 5;2:e01202. doi: 10.7554/eLife.01202. PMID: 24192039; PMCID: PMC3816614.
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[24.] Talebi Bezmin Abadi A, Perez-Perez G. Role of dupA in virulence of Helicobacter pylori. World J Gastroenterol. 2016 Dec 14;22(46):10118-10123. doi: 10.3748/wjg.v22.i46.10118. PMID: 28028359; PMCID: PMC5155170.
[25.] Wei L, Singh R, Ro S, Ghoshal UC. Gut microbiota dysbiosis in functional gastrointestinal disorders: Underpinning the symptoms and pathophysiology. JGH Open. 2021 Mar 23;5(9):976-987. doi: 10.1002/jgh3.12528. PMID: 34584964; PMCID: PMC8454481.
The GI-MAP is a comprehensive stool test that utilizes qPCR technology to detect parasites, bacteria, fungi, and more, allowing practitioners to create personalized treatment protocols to address gut dysfunction.
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