The CDSA Markers

The Comprehensive Digestive Stool Analysis provides diagnostic tools for analysis of digestion, colonic environment and absorption.

Digestion

Great Smokies has developed unique detergent extraction and enzymatic analysis procedures that allow quantitative, precise and accurate measurements.^61,62 These methods give physicians the tools for differential diagnosis of digestive conditions as they relate to acute and chronic illness.

Triglycerides: Triglycerides are the major dietary fat component. Elevated fecal amounts reflect incomplete fat hydrolysis and suggest pancreatic insufficiency.

Chymotrypsin: Fecal chymotrypsin is a sensitive, specific measure of proteolytic enzyme activity.^63,64

Decreased values suggest diminished pancreatic output (pancreatic insufficiency), hypoacidity of the stomach or cystic fibrosis. Elevated chymotrypsin values suggest rapid transit time, or less likely, a large output of chymotrypsin from the pancreas.

Iso-butyrate, iso-valerate and n-valerate: New research suggests that these short chain fatty acids can be produced through bacterial fermentation of protein, thus reflecting the presence of undigested protein in the bowel. In a healthy colon, these SCFAs constitute less than 10% of the total concentrations of SCFAs due to the sparse amounts of polypeptides present in the large intestine compared to undigestible carbohydrates. However, an increase in the load of protein in the colon will alter these concentrations. Causes may include pancreatic insufficiency (insufficient proteases), malabsorption or gastrointestinal disease, leading to mucosal desquamation.⁶⁵

Absorption

Long Chain Fatty Acids: These free fatty acids are readily absorbed by healthy mucosa. In cases of malabsorption, however,they accumulate and reach substantially elevated levels in the feces. They can also indicate pancreatic insufficiency.

Cholesterol: Fecal cholesterol comes from both dietary sources and mucosal epithelial cell breakdown. Some of this cholesterol is absorbed, stored and used by the body, but some is excreted. The fecal cholesterol level remains surprisingly constant during fluctuating exogenous intake. An elevated cholesterol level in feces is abnormal and may reflect mucosal malabsorption.

Total Fecal Fat: This parameter is the sum of all the lipids except SCFAs. It can be indicative of maldigestion or malabsorption. It has been suggested that elevated long chain fatty acid levels reflect malabsorption, and elevated triglyceride levels reflect maldigestion.

Total Short Chain Fatty Acids: A special property of colonic bacteria is their fermentation of soluble fibers to short chain fatty acids (acetate, propionate, butyrate and valerate).⁶⁶ These molecules normally are readily absorbed so that fecal levels reflect a balance between production and absorption. SCFAs provide up to 70% of the energy for colonic epithelial cells.⁵⁶ SCFA production may be an important factor in establishing and maintaining a balanced ecosystem in the colon and may prevent establishment of pathogenic microbes such as Salmonella and Shigella species.

One interesting report suggests that diversion colitis might be successfully treated with rectal irrigations of SCFAs, specifically butyrate.⁶⁷ Elevated levels of the four main SCFAs may reflect colonic malabsorption or bacterial overgrowth. Elevated levels are also found in active colitis.⁶⁸ Decreased levels may reflect insufficient dietary fiber or disruption of the normal colonic flora.

Colonic Environment

Microbiology

Beneficial bacteria:

Healthy amounts of Lactobacilli, Bifidobacteria, and E. coli are essential to the maintenance of a healthy system. Lactobacilli and Bifidobacteria species, in particular, have long been noted for their contributions to intestinal health—from the inhibition of gut pathogens and carcinogens, control of intestinal pH and the reduction of cholesterol tothe synthesis of vitamins and disaccharidase enzymes.

In a healthy gut, these organisms make up a substantial portion of the 400-plus species of bacteria; Bifidobacteria alone comprises up to one-quarter of the total flora in a healthy adult. Reduced numbers of these organisms, resulting from the use of broadspectrum antibiotics, chronic maldigestion or bacterial overgrowth, leave the intestine susceptible to invasion by pathogens and production of carcinogens. Measurement of their levels may indicate the need to supplement with “friendly bacteria” to restore these important properties. While E. coli do not share some of these direct beneficial effects, clinical observation suggests ample amounts of these organisms are present in healthy intestines.⁶⁹

Additional bacteria:

Bacteriology cultures quantitate normal flora (Lactobacilli, Bifidobacteria, E. coli and other frequently isolated organisms), imbalanced flora and potential pathogens. Sero-typing for toxigenic E. coli and Campylobacter cultures is performed on diarrhetic specimens.

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