Stool Testing Support Guide Genova Diagnostics Stool Support Guide Table of Contents Introduction .........................................................................................................................................3 Biomarker Comparison Charts ................................................................................................4-5 GI Effects Results Overview ...........................................................................................................6 Functional Imbalance Scores ....................................................................................................7 Therapeutic Support Options ..................................................................................................7 GI Effects Commensal Microbiome Analysis .........................................................................8 Commensal Abundance ..........................................................................................................8 Total Commensal Abundance ............................................................................................8 Relative Commensal Abundance ......................................................................................8 Commensal Dysbiosis Patterns ...........................................................................................9 REFLEX Inflammation-Associated Dysbiosis (IAD) Score ..........................................................9 Methane Score .........................................................................................................................9 BLASTOCYSTIS Dysbiosis Zones Graphic ......................................................................................................9 SUBTYPING Commensal Balance ................................................................................................................10 Reference Variance Score ...................................................................................................10 1-9: Healthy-Pattern Continuum ..............................................................................................10 Digestion and Absorption ...........................................................................................................11 N-BUTYRATE Pancreatic Elastase 1 ...........................................................................................................11-12 DIG Products of Protein Breakdown (Putrefactive Short Chain Fatty Acids) ................13 Fecal Fats .................................................................................................................................14-15 Chymotrypsin ...............................................................................................................................15 Meat and Vegetable Fibers ......................................................................................................16 Inflammation and Immunology ................................................................................................17 COMMENSAL Calprotectin ..................................................................................................................................17 O&P Eosinophil Protein X ...................................................................................................................18 BACTERIA Fecal secretory IgA .....................................................................................................................19 ZONULIN Fecal Lactoferrin ..........................................................................................................................20 Gastrointestinal Microbiome .....................................................................................................21 FAMILY Metabolic Indicators ...............................................................................................................22 PEPTIDE Short chain fatty acids ..................................................................................................22-23 Beta-glucuronidase ..............................................................................................................24 RELATIVE pH ...............................................................................................................................................25 Secondary Bile Acids ............................................................................................................26 ABUNDANCE Commensal Bacteria ...............................................................................................................27 GASTROINTESTINAL PCR Commensal Bacteria ............................................................................................28-29 Firmicutes/Bacteroidetes Ratio ........................................................................................30 MICROBIOMEFECAL Dysbiosis ..................................................................................................................................30 Clinical Associations Charts ........................................................................................31-32 LACTOFERRIN Bacteriology and Mycology ................................................................................................33 Bacteriology and Mycology Culture...............................................................................33 Bacteriology and Mycology Sensitivities...............................................................34-35 Potassium Hydroxide (KOH) Prep for Yeast ..................................................................35 Pathogenic Bacteria Enzyme Immunoassay (EIA) (Add-on only) ........................36 Parasitology ................................................................................................................................37 Microscopic ova and parasites (O&P) .....................................................................37-38 PCR Parasitology - Protozoa ..............................................................................................39 EIA Parasitology .....................................................................................................................40 Macroscopic Exam for Worms ..........................................................................................40 Therapeutic Considerations for Parasitology .......................................................40-41 ReflexBlastocystis subtyping 1-9 .............................................................................41-44 Additional tests.................................................................................................................................45 Occult Blood .................................................................................................................................45 Zonulin Family Peptide (Add-on only) ................................................................................45 References ....................................................................................................................................46-52 2 INTRODUCTION Advances in research, combined with clinical insight, confirm the essential role of the gut in determining overall health and wellness. Genova’s stool profiles offer a comprehensive evaluation of GI function paired with the broadest clinical utility available. It is important that clinicians possess these tools since they provide the most accurate and comprehensive assessment of gastrointestinal health. Genova’s line of stool testing provides immediate actionable clinical information for gastrointestinal health management. Utilizing both advanced technologies and premier biomarkers, the GI Effects Stool Profiles and CDSA/CDSA 2.0 Profiles offer valuable insight into digestive function, intestinal inflammation, as well as the gastrointestinal microbiota. Our tests are designed to identify potential root causes of symptoms. They assist clinicians by providing targeted therapeutics that improve symptoms and overall gut health. In addition to providing a comprehensive set of GI functional biomarkers, our stool profiles incorporate the most sophisticated tools in evaluating the microbial community of the GI tract, known as the microbiota. Genova uses multiple methodologies to provide the most clinically accurate assessment of bacteria, yeast, and parasites currently available on the market. The GI Effects Profiles include quantitative assessment of commensal bacteria to determine healthy bacterial balance based on research and analysis of hundreds of thousands of patient results. This data-driven, evidence-based analysis establishes a firm foundation from which to base clinical decisions and treatment. Lastly, the GI Effects utilizes an innovative scoring system that synthesizes the biomarker findings and groups them into 5 key areas relating to GI function: maldigestion, inflammation, dysbiosis, metabolite imbalance, and infection. This allows for clearer visualization of patterns among biomarkers. Protocol design and management of abnormal GI function through dietary, lifestyle, nutraceutical, and other relevant interventions are thus enhanced. 3 Gut Pathogen Prole GI Effects® Biomarkers Comparison Table 2200* 2205* 2207* *Not Available in New York Digestion and Absorption Pancreatic Elastase-1 • Products of Protein Breakdown (Total) (Valerate+Isobutyrate+Isovalerate) • Fecal Fat (Total) • Triglycerides • Long Chain Fatty Acids • Cholesterol • Phospholipids • Inflammation and Immunology