• Digestive symptoms: Chronic diarrhoea, constipation, bloating, gas or abdominal pain.
• Altered bowel habits: Ongoing changes in stool frequency, urgency or consistency.
• Suspected gastrointestinal disorders: Evaluation in contexts such as irritable bowel syndrome, inflammatory bowel disease or coeliac disease.
• Recurrent gastrointestinal symptoms: Exploration of potential bacterial contributors including Escherichia coli or Helicobacter pylori.
• Malabsorption concerns: Unexplained weight loss, anaemia or signs of nutrient insufficiency.
• Immune-related conditions: Investigation of gastrointestinal factors in autoimmune or inflammatory presentations.
• Skin conditions: Eczema, acne or psoriasis where gut involvement is considered.
• Fatigue or neurological symptoms: Brain fog, low energy or mood changes in complex clinical presentations.
• Altered gut barrier function: Assessment of intestinal permeability where disruption of gut lining integrity is suspected.

Overview

The Gastrointestinal Microbial Assay Plus (GI-MAP) with zonulin is an advanced stool test that measures gastrointestinal microbiota DNA together with key immune, digestive and intestinal barrier markers from a single stool sample using quantitative polymerase chain reaction (qPCR) technology.

The panel provides insight into microbial balance and potential contributors to gastrointestinal dysfunction. It assesses a wide range of organisms that may influence gut health, including pathogenic bacteria, commensal bacteria, opportunistic organisms, fungi, viruses and parasites, alongside functional markers such as calprotectin, secretory IgA, pancreatic elastase and zonulin, a marker associated with regulation of intestinal barrier integrity. This combined assessment supports a more comprehensive understanding of how microbial patterns and gut barrier function may relate to digestive symptoms or broader health presentations.

Results are interpreted alongside clinical history, digestive function and environmental factors. Quantitative reporting allows comparison over time to help review changes in microbial patterns following dietary, lifestyle or therapeutic interventions. Additional GI-MAP add-ons include StoolOMX (bile acids and short-chain fatty acids) and gluten peptide.

Practical

Specimen

Stool sample 

Container

• 1x orange-capped stool vial

Patient preparation

• Please refrain from taking aspirin for two days prior to collecting your sample.
• Never discontinue prescription medication without first consulting your physician.

Age requirements

Can be used on all ages. However, often the microbiome of infants will appear very “dysbiotic”, as the microbiome and the infant’s immune system is very immature.

Medications

We recommend continuing all prescription medications prior to testing. Please carefully document any relevant recent or current medication use. Medications that may alter the composition of the microbiome include:

• Antibiotics -(after finishing Antibiotics, wait 4-6 weeksbefore collecting sample)
• Immune Suppressants/ Oral steroids- will likely cause a lower Secretory IgA, Anti-gliadin, and calprotectin result (after finishing these meds, wait 4-6 weeks before collecting sample)

Gastroenterology Procedures:
Wait at least 4 weeks from colonoscopy or barium enema before beginning the test.

Supplements:
It is not necessary to discontinue most supplements before testing.  It is the provider’s discretion to recommend discontinuing supplements.  Many providers will want to understand the impact of supplements on the gut ecosystem and will want their patients to continue supplements during testing.  If a provider wants more of a “baseline” assessment using the GI-MAP, they may recommend discontinuing supplements prior to testing. There are a few categories of supplements that deserve consideration:

Non-prescription anti-microbial agents:
While we don’t require that people discontinue antibiotics or antimicrobial substances before collection their stool sample, doing the test while taking these substances can influence the test results.  If possible, we recommend discontinuing anti-microbial agents 4-6 weeks before testing.

Enzymes:
Oral enzyme use will not change the elastase-1 finding. If the enzyme contains lipase or ox bile, it may decrease the value for steatocrit.

Ox Bile/Lipase:
Ox bile/lipase intake will affect the steatocrit level but will not affect Elastase-1. If you would like to see your patient’s baseline without supplementation, discontinue at least 3 days before testing. If you would like to see how well-managed your patient is on their supplement, do not discontinue.

Probiotics:
Probiotic supplements can influence the normal and opportunistic bacteria flora. If you would like to assess your patient’s baseline microbial balance without supplementation, discontinue for ~2 weeks prior to testing. If you would like to see the influence of the current probiotic supplement, do not discontinue prior to testing.  

Biofilm disruptors:
There is no published evidence to suggest that a biofilm disruptor will improve detection of organisms. However, some clinicians choose to use a biofilm disruptor with their patients up to 14 days before testing. This is an option but not a requirement for testing.

Research

1. Abubakar I, Irvine L, Aldus CF, et al. A systematic review of the clinical, public health and costeffectiveness of rapid diagnostic tests for the detection and identification of bacterial intestinal pathogens in faeces and food. Health Technol Assess. 2007;11(36):1-216.
2. Amar CF, East CL, Gray J, Iturriza-Gomara M, Maclure EA, McLauchlin J. Detection by PCR of Eight groups of enteric pathogens in 4,627 faecal samples: re-examination of the English casecontrol Infectious Intestinal Disease Study (1993-1996). Eur J Clin Microbiol Infect Dis. 2007;26(5):311-323.
3. Bischoff SC, Barbara G, Buurman W, et al. Intestinal permeability — a new target for disease prevention and therapy. BMC gastroenterology. 2014;14:189.
4. Canny GO, McCormick BA. Bacteria in the intestine, helpful residents or enemies from within? Infection and immunity. 2008;76(8):3360-3373.
5. Fasano A, Shea-Donohue T. Mechanisms of disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases. Nature clinical practice. 2005;2(9):416-422.
6. Iijima Y, Asako NT, Aihara M, Hayashi K. Improvement in the detection rate of diarrhoeagenic Bacteria in human stool specimens by a rapid real-time PCR assay. Journal of medical microbiology. 2004;53(Pt 7):617-622.
7.  Kahlau P, Malecki M, Schildgen V, et al. Utility of two novel multiplexing assays for the detection of gastrointestinal pathogens - a first experience. SpringerPlus. 2013;2(1):106.
8. Kamada N, Seo SU, Chen GY, Nunez G. Role of the gut microbiota in immunity and inflammatory disease. Nature reviews. Immunology. 2013;13(5):321-335.
9. Khanna S, Tosh PK. A clinician's primer on the role of the microbiome in human health and disease. Mayo Clinic proceedings. 2014;89(1):107-114.
10. Othman M, Aguero R, Lin HC. Alterations in intestinal microbial flora and human disease. Current opinion in gastroenterology. 2008;24(1):11-16.
11.  Rashid T, Ebringer A. Autoimmunity in Rheumatic Diseases Is Induced by Microbial Infections via Crossreactivity or Molecular Mimicry. Autoimmune diseases. 2012;2012:539282. 
12. Schabereiter-Gurtner C, Hirschl AM, Dragosics B, et al. Novel real-time PCR assay for detection of Helicobacter pylori infection and simultaneous clarithromycin susceptibility testing of stool and biopsy specimens. Journal of clinical microbiology. 2004;42(10):4512-4518.
13. Stecher B, Hardt WD. The role of microbiota in infectious disease.Trends in microbiology. 2008;16(3):107-114.
14.  Tiwana H, Wilson C, Walmsley RS, et al. Antibody responses to gut bacteria in ankylosing spondylitis, rheumatoid arthritis, Crohn's disease and ulcerative colitis. Rheumatology international. 1997;17(1):11-16.

See also Brochure under ‘Downloadable files’ for even more research.