| Humoralpathologisches Forschungslabor | Stool test

Standard examination

Our standard examination comprises the following parameters:

A1 Gram-positive bacterial flora
A2 Gram-negative bacterial flora
A3 Obligate pathogen bacterial flora
A4 Mycological examination
A5 Intestinal gas producers (clostridium)
A6 Bacterial microscopic findings
A7 pH-value
A8 Chemical blood analysis
A9 Microscopic investigation of the nutritional absorption
A9.1 Starch – homogenously engrossed
A9.2 Starch
A9.3 Neutral fat
A9.4 Fatty acids
A9.5 Muscle fibres

A1, A2 Gram-positive and gram-negative bacterial flora

The physiological intestinal flora normally consists of bacteria, which, according to the way they are coloured, are sorted into gram-positive or gram-negative bacteria. Bacteria, such as Enterococci, aerobe spore creators or alpha-haemolysing Streptococci are part of the gram-positive bacterial flora. The number of bacteria in the finding is indicated as minor, moderate or increased.

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A3 Obligate pathogen bacterial flora

Among the multitude of bacteria, various species, particularly the entero bacteria class, can through their bacterial metabolism cause gastric- and intestinal problems. Furthermore, this metabolic yield may harm the intestinal mucosa and add stress on the detoxifying function of the liver.

If these bacteria were to exist in greater numbers, it should be considered that they also would have a capacity to enter the small intestine. As a bacteriological stool-examination will not provide information on the existence of bacteria in the small intestine, other means will be used. If an exceeding amount of bacteria exists in the small intestine, their metabolic yield will be detoxified in the liver and kidneys. The quantitative result of the total contents of phenol from morning and evening urine includes a considerable part of these metabolites and are subsequently of precious diagnostic assistance (see 5, urine examinations).

In contrast to those bacteria which may cause inconvenience due to their growth in the wrong place, there is Salmonella and Shigella which are part of the group which causes enteritis. A particular procedure is needed to indicate their existence and the findings are treated in a special way.

Attention: Entero pathogen bacteria such as Salmonella, Shigella, Campylobacter jejuni/coli, Yersinia, pathogen carriers of intestinal E. coli, Clostridium Difficile, Helicobacter Pylori etc are obligatory to report, according to §§ 3-5 in the German legislation regarding communicable diseases.

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A4 Mycological examination

The mycological examination includes the indication of yeast and fungus. Among the yeast fungi, the clinically important Candida is particularly examined.

Candida is one of the most common yeast fungi in faeces. If for example Candida Albicans is diagnosed, then the likeliness of mycosis should also be taken into consideration. Particularly this concerns patients who have been on antibiotics or cortisone and even those whose immune system has been weakened for unknown reasons. To obtain a successful result with the treatment of pathogen yeast fungi it is of utmost importance to observe all locations such as the mouth or the anal-genital areas.

Normally the fungal growth in the intestine is not a causing process – the mycosis in particular does not provide us with a conclusive description of disease – but is a result of the state in the intestinal environment, which is due to a debilitation of the defence caused by foreign bacteria.

Subject to the symptoms in each case, a proper diet may suffice for some, while others must receive a supplementary anti-mycotic treatment. It is frequently very difficult to totally eliminate yeast fungi.

The examinations after concluded treatment should then absolutely verify the results of the taken actions (see offer C) in the pricelist, (examination of yeast fungi and fungi in the gastrointestinal tract).

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A5 Intestinal gas producers (Clostridia)

The intestinal gas producers, which physiologically exist in faeces, are summarized as Clostridium. If these exceed a critical concentration in the stool, it is highly possible that they also exist in an increased number in the colon.

A high concentration of Clostridium may lead to metabolic disturbances via the degradation of nutritive substances. E.g. by an increased degradation of protein, biogenic amines could be produced through the Clostridium. Clinical symptoms in these cases often consist of discomfort in the upper part of the abdomen such as meteorism or flatulence.

Various causes of intestinal diseases such as Campylobacter or Clostridium Difficile are very complicated to verify and a rapid transport of the samples is necessary. If suspicion remains on any of these diseases, further examinations must be started immediately.

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A6 Bacterioscopic findings

The demonstration of iodiphil bacteria indicates the occurrence of saccharolytic dysbacteria. At a positive finding particular consideration should be taken to the pH value as evidence of gas producers.

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A7 pH value

The micro flora in the intestine has an influence on the pH value in the faeces through its metabolism. The pH value in faeces indicates decomposition- or fermenting conditions in colon and is a further interpretational aid in combination with bacterioscopic examination results.

For a healthy intestine an adult should have a pH value between 6,5 and 6,8.

A high pH value (>7) coinciding with strong evidence of intestinal gas producers or enterobacteria as Proteus or Pseudomonas indicate proteolytic dysbacteria. Large amounts of protein stimulate the proteolytic active intestinal bacteria, which by the metabolic production of ammonia and other metabolic products, result in an alkalisation of faeces.

On the contrary. A low pH value (<5) – often combined with an increased number of saccharolytic bacteria and/or intestinal gas producers – is evidence of saccharolytic dysbacteria. Thereby, e.g. complex sugar species are metabolised to fatty acids through the saccharolytic bacterial flora and affects in this way an acidification of faeces.

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A8 Chemical blood examination

The chemical blood examination is a qualitative marker for intestinal bleedings caused by unclear or chronic inflammatory intestinal diseases.

When suspected, or to enable a confirmation of the degree of seriousness of inflammations in the colon, plasma proteins in faeces can also be examined (see analysis of human serum albumin, ceruloplasmin, transferrin).

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A9 Microscopic examination of nutritional uptake

The microscopic examination of nutritional uptake provides information about several digestive problems of various geneses. Through special colourings it is possible to microscopically indicate and quantify digestive residues such as starch, neutral fat, fatty acids, muscle fibres, connective tissue and elastic fibres.

These examinations enable discovery of a first sign of disturbances like impaired digestion/mal-absorption and should be confirmed immediately through further examinations. By normal digestive capacity, none or minor amounts of muscle fibres, starch, neutral fat and fatty acids are found in faeces.

A.9.1 Starch homogenously swelled

An increased amount of homogenously swelled starch indicates a disturbed digestion in the small intestine.

A9.2 Starch

An increased amount of starch in faeces (moderate [++] to increased [+++] content) is mostly due to poor carbohydrate metabolism. The cause is often an excretory pancreas insufficiency with decreased secretion of carbohydrate decomposing enzymes.

It is advisable to verify this finding through analysis of pancreas-elastase 1 in faeces.

A9.3 Neutral fat

An increased content of neutral fat in faeces (moderate [++] to increased [+++] content) indicates insufficient uptake of nutritional fat.

The causes can be incomplete fat emulsification due to disturbed gall secretion, disturbed bile acid resorption or incomplete secretion of fat decomposing enzymes in pancreas.

This finding should be confirmed by further laboratory diagnostic examinations of the bile acids in faeces (see A2 Examinations of bile acids in faeces).

A9.4 Fatty acids

An increased amount of fatty acids in faeces (moderate [++] to increased [+++] content) indicates a disturbance of the resorption in the small intestine. Possible causes can be inflammatory lesions in the small intestine.

This finding should be verified through analysis of inflammatory markers such as PMN-elastase.

A9.5 Muscle fibres

The presence of muscle fibres in faeces (moderate [++] to increased [+++] content) indicates a decreased protein metabolism. The causes can be an excretory pancreas insufficiency with lowered secretion of proteolytic enzyme (chronic disease in pancreas with alteration of the pH-value in the small intestine) and/or a disturbed protein metabolism in the stomach (Pepsin).

In these cases, considering clinical findings, analysis of chymotrypsin- or pancreas-elaste 1 content in faeces is recommended.


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