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Unpacking your Irritable Bowel

IBS affects over 20% of Australians with a long list of all too familiar and awkward symptoms that include abdominal pain, cramping or discomfort, bloating, diarrhoea and/ or constipation, mucus, excess wind, and indigestion. Only recently have we begun to unpack the mysteries of IBS. Whilst we don't yet know exactly what causes it, a number of causal factors have been put forward, which range from genetics, the immune system, the microbiome and infections, to diet, stress and even mental health. Since many gut disorders have similar symptoms to IBS, ruling out a more serious underlying gut disease is an important first step in troubleshooting the irritable bowel.

What we test

Faecal Macroscopy

Macroscopy looks at stool colour and formation, as well as for evidence of mucous or blood which may require further investigation.

This macroscopy test measures

Brown is the colour of normal stool. Other colours may indicate abnormal gastrointestinal conditions.

A formed stool is considered normal. Variations to this may indicate abnormal gastrointestinal conditions.

Mucous production may indcate the presence of an infection, inflammation or malignancy.

This test is used to detect bleeding in the digestive tract, and is used in Australia's National Bowel Screening program. This test can detect tiny traces of blood in the stool, and can indicate the presence of disease at a relatively early stage when stools may appear normal.

Digestive & Metabolic Markers

Microscopy is performed for detection of blood cells which may indicate infections or inflammation, as well as markers of maldigestion. The presence of food remnants may indicate poor digestion from too little gastric acid or reduced output from the pancreas.

This microscopy test measures

Imbalances in gut pH influence short chain fatty acid production and their effect.

The presence of red blood cells in the stool may indicate the presence of an infection, inflammation or haemorrhage.

The presence of white blood cells in the stool may indicate the presence of an infection, inflammation or haemorrhage.

The presence of food remnants may indicate maldigestion.

The presence of meat fibres may indicate maldigestion from too little gastric acid or reduced output from the pancreas.

The presence of vegetable fibres may indicate maldigestion from gastric hypoacidity or diminished pancreatic output.

Too much fat in your faeces is called steatorrhoea which can be a sign of malabsorption. This means your body either isn’t absorbing nutrients properly or isn’t making the enzymes or bile needed to digest food effectively.

The presence of starch grains may indicate carbohydrate maldigestion.

PCR Test - Bacteria

Technology for detecting parasites and other pathogens has improved dramatically since 2013. This PCR (polymerase chain reaction) test looks for the genetic fingerprint of a wide range of pathogens. This is a far more sensitive test than the old fashioned technique of looking through a microscope.

This faecal multiplex PCR test detects the following pathogenic bacteria:

Salmonella infection usually results from ingestion of the bacteria from contaminated food, water or hands. Eggs, milk, meat or poultry are particularly high risk foods.

Campylobacter infection (campylobacteriosis) is a bacterial infection which most commonly causes gastroenteritis (also known as 'gastro') but may also cause illness affecting the entire body.

Shigella infection (shigellosis) is a type of gastroenteritis caused by Shigella bacteria. The symptoms of Shigella infection include fever, diarrhoea, (sometimes with blood and mucous), vomiting and stomach cramps.

This infectious bacteria can cause gastroenteritis and symptoms beyond the gut. Symptoms include diarrhoea, nausea, vomiting, fever and abdominal pain. It can mimic appendicitis or Crohn's disease.

Aeromonas are bacteria that can cause an acute diarrhoeal illness that normally clears without treatment. It is a fairly common cause of gastroenteritis, which occurs most often throughout the warm summer months in most countries.

Plesiomonas shigelloides is a bacteria found in aquatic environments that has been associated with sporadic cases and outbreaks of diarrhoeal disease.

PCR Test - Parasites

Technology for detecting parasites and other pathogens has improved dramatically since 2013. This PCR (polymerase chain reaction) test looks for the genetic fingerprint of a wide range of pathogens. This is a far more sensitive test than the old fashioned technique of looking through a microscope.

This faecal multiplex PCR test detects the following parasites:

Symptoms of Giardia infection can occur with 3 to 25 days and may include diarrhoea, nausea, vomiting, pale greasy foul-smelling stools, stomach cramps, passing excess gas, bloating, weight loss and fatigue.

Cryptosporidium is a microscopic parasite that causes the diarrhoeal disease cryptosporidiosis. Both the parasite and the disease are commonly known as "Crypto."

The bacteria can be present in the gut for months or year and misdiagnosed as IBS. Infection can cause diarrhoea, abdominal pain and cramping, anal itching, nausea, loss of appetite, headache, dizziness, depression, weight loss and fatigue.

Amoebiasis is a parasitic disease (also known as amoebic dysentery) caused by infection with Entamoeba histolytica or another amoeba (for example, E. dispar). The disease may not cause symptoms in most individuals.

Some research suggests that people with IBS may be more likely to have Blastocystis hominis organisms in their stool.

Ova, Cysts and Parasites

This microscopic evaluation is used to look for parasites that have infected the lower digestive tract. The parasites, or their eggs or cysts can be detected under the microscope.

This stool test measures

The ova refers to the eggs of the parasite which are visible under a microscope. The majority of people who are infected by gut parasites become infected by drinking water or eating food that has been contaminated with the parasite eggs.

Refers to the cellular form of a parasite that has a thick cell wall which allows for survival of the parasite in the environment and transmission into an uninfected host.

Parasites that have infected the lower digestive tract are shed into the stool.

Gut Inflammation

These tests are used to detect inflammation in the body, which may be caused by Inflammatory Bowel Disease (such as Crohn's or ulcerative colitis).

This blood and stool test measures:

This protein is released into the stool when the intestinal lining is damaged. It's usually very high in cases of Inflammatory Bowel Disease (such as Crohn's or ulcerative colitis), and low in IBS. Calprotectin is also elevated with gut infections and colon cancers.

A high-sensitivity C-reactive protein (hs-CRP) test measures low levels of CRP and may be used to help evaluate an individual for risk of cardiovascular disease

Beneficial Bacteria

Significant numbers of bacteria are normally present in the healthy gut. Lactobacilli and Bifidobacteria in particular, are essential for gut health because they help to inhibit gut pathogens and carcinogens, control pH, reduce cholesterol and synthesise vitamins.

This stool test measures

Bifidobacteria are considered "friendly” bacteria that are found in fermented foods like yogurt and cheese, and are used in probiotics. The gut needs these bacteria to perform several jobs, including breaking down foods, taking in nutrients, and preventing overgrowth of "bad” pathogenic bacteria.

Lactobacilli and Bifidobacteria are essential for gut health because they prevent overgrowth of gut pathogens, and contribute to managing intestinal pH, cholesterol, and synthesis of vitamins and disaccharidase enzymes.

Most E. coli strains are harmless and play an essential role in keeping the digestive system healthy, helping to digest food and producing Vitamin K. However, some E. coli bacteria are pathogenic and can cause disease.

Together with other healthy bacteria and fungi, enterococci work to keep unhealthy (pathogenic) bacteria from flourishing and helps to restore the balance of the microbiome.

Potentially Pathogenic Bacteria

This panel also looks for evidence of other bacteria which may be pathogenic in nature, such as Citrobacter and Klebsiella.

This stool test measures

Klebsiella forms part of the normal gut flora in small numbers, but can be an opportunistic pathogen

Citrobacter is considered an opportunistic pathogen and therefore can be found in the gut as normal flora. It is occasionally implicated in diarrhoeal disease, particularly C. freundii, C. diversus and C. koseri.

Pseudomonas is found in water and soil as well as fruits and vegetables, and is considered an opportunistic pathogen.

Part of the normal flora of the gastrointestinal tract, though has been shown to be an independent causative agent of intestinal disorders. May also play a role as an opportunistic organism in enteric infection due to other pathogens. Food has been implicated as a vehicle of infection.

Campylobacter infection (campylobacteriosis) is a bacterial infection which most commonly causes gastroenteritis (also known as 'gastro') but may also cause illness affecting the entire body.

Salmonella infection usually results from ingestion of the bacteria from contaminated food, water or hands. Eggs, milk, meat or poultry are particularly high risk foods.

Streptococcus is common in the gut flora. With the exception of very rare cases, streptococcus species are not implicated in gastric disease.

Yersinia infection (yersiniosis) is a bacterial infection of the bowel (intestine). It occurs worldwide, but is fairly uncommon. Many domesticated and wild animals carry Yersinia in their intestines, and spread to people occurs by eating food or water contaminated by infected faeces.

Enterococcus species are part of normal flora in the human gut, but can however be implicated in a variety of infections of which urinary tract infections are the most common.

Most E. coli strains are harmless and play an essential role in keeping the digestive system healthy, helping to digest food and producing Vitamin K. However, some E. coli bacteria are pathogenic and can cause disease.

Other bacteria tested for include alpha-haemolytic Streptococcus, gamma-haemolytic Streptococcus, Pseudomonas species, Pseudomonas stutzeri, Bacillus species, Citrobacter amalonaticus, and Klebsiella pneumoniae

Yeasts

This test looks for evidence of candida or other yeast overgrowth. Whilst yeasts are a normal inhabitant of the gastrointestinal tract, they may become an opportunistic pathogen after disruption of the mucosal barrier, imbalance of the normal intestinal flora or impaired immunity. This can be caused by things like antibiotics, antacids and stress.

This stool test measures

Candida albicans is the main type of yeast which colonises the human body. It normally lives in the gastrointestinal tract and other areas of the body without causing problems, but imbalance in the microbiome can lead to overgrowth.

Geotrichum yeasts can be found in soil, dairy products and in human skin and mucosae, and are usually only considered an opportunistic pathogen in immune-compromised hosts. Geotrichum may play a role in IBS.

A common environmental yeast which is not considered pathogenic in nature. These yeasts are ubiquitous in the environment and can be found on fruits, vegetables and other plant materials.

Whilst yeasts are a normal inhabitant of the gut, they may become an opportunistic pathogen after disruption of the mucosal barrier, imbalance of the normal intestinal flora or impaired immunity. This can be caused by things like antibiotics, antacids and stress.

Coeliac Screen

People with coeliac disease who eat gluten have higher than normal levels of tissue transglutaminase antibodies in their blood. These antibodies are produced by the immune system because it views gluten - the proteins found in wheat, rye and barley - as a threat. This gluten intolerance test is positive in about 98% of patients with coeliac disease who are on a gluten-containing diet.

This coeliac serology test measures:

The tTg antibodies test is the most sensitive and specific gluten intolerance test for coeliac disease. This tTG blood test can also be used to help evaluate the effectiveness of treatment as antibody levels should fall when gluten is removed from the diet.

Nutrient Malabsorption

If the intestines can't absorb nutrients then they are eliminated from the body in the stool. This can happen when there's damage to the intestine, as well as the amount of time available where nutrients can be absorbed from food as it passes through the gut.

This blood test measures common nutritional deficiencies associated with malabsorption:

The ferritin concentration within the blood stream reflects the amount of iron stored in your body and is reduced in anaemia.

A measure of all of the proteins in the plasma portion of your blood. Proteins are important building blocks of all cells and tissues - they are important for body growth and health.

Plays a critical role in developing and maintaining your overall bone health. If the total calcium result is abnormal, a corrected calcium calculation provides further information.

Magnesium and calcium work together closely to maintain strong bones, and magnesium deficiency has been associated with an increased risk of osteoporosis.

Most phosphate in the body comes from foods such as beans, peas and nuts, cereals, dairy products, eggs, beef, chicken and fish contain small amounts of phosphate. Phosphates are vital for energy production, muscle and nerve function, and bone growth.

The main storage form of fatty acids in the body. Elevated triglyceride levels may contribute to hardening of the arteries, and increase the risk of heart disease or stroke.

Pancreatic Function

Proteins, fats, and carbohydrates are broken down by stomach acids, enzymes produced by the pancreas, and bile from the liver. This process also releases micronutrients. This blood test measures the levels of enzymes produced by the pancreas.

This blood test measures:

An enzyme produced by the pancreas which is released into the digestive tract to help digest fatty foods.

An enzyme made mainly by the pancreas which is released from the pancreas into the digestive tract to help digest starch in our food.

Liver Function

Your liver processes drugs and alcohol, filters toxic chemicals, stores vitamins and minerals, and makes bile, proteins and enzymes. This liver function test examines enzymes and other markers for evidence of damage to your liver cells or a blockage near your liver which can impair its function.

This liver function test measures:

Bilirubin tests are use to screen for or to detect and monitor liver disorders or haemolytic anaemia.

Alkaline phosphatase (ALP) is an enzyme located mainly in the liver and the bones. High levels can indicate liver disease.

Aspartate aminotransferase (AST) is an enzyme created mainly by the liver and the heart. High levels can indicate damage to your liver caused by alcohol, drugs or hepatitis.

Alanine aminotransferase (ALT) is an enzyme mainly produced by the liver. A good indicator of liver damage caused by alcohol, drugs or hepatitis.

Gamma-glutamyl transferase (GGT) is a liver enzyme which can be used to diagnose alcohol abuse as it is typically raised in long term drinkers.

Albumin is a protein which keeps fluid from leaking out of blood vessels, nourishes tissues, and carries hormones, vitamins, drugs, and ions like calcium throughout the body. Albumin is made in the liver and is sensitive to liver damage.

A measure of all of the proteins in the plasma portion of your blood. Proteins are important building blocks of all cells and tissues - they are important for body growth and health.

Kidney Function

This panel of tests is used to detect electrolyte imbalances that could be impacted by malabsorption and diarrhoea.

This blood test measures:

Helps regulate the water and electrolyte balance of your body, and is important in the function of your nerves and muscles. Too much sodium can indicate kidney disease.

Minor changes in serum potassium ca have significant consequences. An abnormal concentration can alter the function of the nerves and muscles for example, the heart muscle may lose its ability to contract.

Chloride, like sodium, helps to maintain the balance of fluid in the body. Raised levels can be caused by eating too much salt, dehydration, diarrhoea, certain medications and also kidney disease.

Higher than normal levels suggests trouble maintaining pH balance either by failing to remove carbon dioxide or because of an electrolyte imbalance. Elevations may be seen with severe vomiting, chronic lung problems and some hormonal disorders. Low levels may be seen with chronic diarrhoea, diabetic ketoacidosis and kidney failure.

A high concentration of this waste product can indicate dehydration or that your kidneys aren’t working properly.

A waste molecule generated from muscle metabolism, and an accurate marker of kidney function.

The estimated glomerular filtration rate (eGFR) measures how well your kidneys filter the wastes from your blood and is the best overall measure of kidney function.

Test instructions

Take your form to one of our affiliated collection centres to have your blood sample taken - no need for an appointment - www.i-screen.com.au/blood-testing-centres.

Fast from all food and drink (other than water) for at least 8 hours, and no more than 12 hours prior to your test.

Your test kit for your stool sample and all instructions are posted directly to you.

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