Gastrointestinal infections are among the most common bacterial, viral, and parasitic infections in the world, affecting about 1.7 billion people annually, and accounting for the death of more than 750,000 children under the age of five worldwide1. About 1 in 6 Americans, or 48 million people, contract gastrointestinal infections every year in the United States alone.2

The most common bacterial, viral, and parasitic causes of gastrointestinal infections include:

  • Clostridium difficile (bacterial)
  • Escherichia coli (bacterial)
  • Shigella (bacterial)
  • Norovirus (viral)
  • Rotavirus (viral)
  • Cryptosporidium (parasitic)
  • Giardia (parasitic)1

Typically, gastrointestinal infections, no matter the type, are a result of contaminated food or water and/or poor sanitation practices.

Gastrointestinal Infections Difficult to Test

Testing for gastrointestinal infections poses several difficulties. Conventional stool and antigen tests are the most common ways to test for infection, but these tend to have low sensitivity and, in the case of evaluating stool samples, can be laborious. Microscopy is another traditional testing option but also has low sensitivity, is labor-intensive, and requires specialized training. While antigen tests are more sensitive, they are limited by the fact that available tests can only detect a handful of parasites.3

The development of molecular and PCR tests significantly improved testing sensitivity, but also share some of the limitations of antigen tests in that they are only useful for single bacterial, viral, or parasitic pathogens. These tests, however, have the distinct advantage of improving turnaround time from 24 to about 1.5 hours.3

Multiplex tests have helped to solve the limitations posed by single pathogen tests, particularly in hospital settings.3

Multiplex testing can evaluate a range of pathogens, saving time and resources for additional testing. However, multiplex testing can be expensive, costing, in some cases, around $200 per test for the lab.4 However, these tests are covered by Medicare for patients exhibiting symptoms.

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Choosing the Right Gastrointestinal Test

While advanced molecular and multiplex tests have a number of advantages, including improved sensitivity and faster turnaround time, evaluating and choosing a specific test type should involve many factors, including:

  • The lab’s ability to perform the test. How will this affect the lab’s workflow? Will this require capital outlays for equipment, personnel, or training?
  • Frequency of testing. Will there be enough volume to justify any additional costs?
  • Reimbursement. Is the test being considered reimbursed by the payors your lab works with? Will there be a timely return on investment?

These and other factors should be considered before adding or updating the lab’s gastrointestinal testing offerings.

References

  1. Matthew J. Binnicker. Multiplex Molecular Panels for Diagnosis of Gastrointestinal Infection: Performance, Result Interpretation, and Cost-Effectiveness. 2015. Journal of Clinical Microbiology. 3723-3728. 53. 12. DOI: 10.1128/JCM.02103-15
  2. “How to Improve Accessibility to Testing for GI Infections.” Patel, Anami. CLPmag.com. March 9, 2023. https://clpmag.com/disease-states/infectious-diseases/gastrointestinal-infections/how-to-improve-accessibility-to-testing-for-gi-infections/
  3. Yuliya Zboromyrska & Jordi Vila (2016) Advanced PCR-based molecular diagnosis of gastrointestinal infections: challenges and opportunities, Expert Review of Molecular Diagnostics, 16:6, 631-640, DOI: 10.1586/14737159.2016.1167599
  4. Gastrointestinal Pathogen Panel Guidance. Van Schooneveld, Trevor; Fey, Paul Fey; Bergman, Scott. May 2021. https://www.unmc.edu/intmed/_documents/id/asp/news/gi-aanel-guidance-2021-final.pdf

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