Intestinal path decision tree

Gut Check: Are Advanced Tests Helping or Hurting IBD Patients?

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Avery Sinclair in Health & Wellness April 2025 • 5 min read.

"A closer look at how multiplex gastrointestinal pathogen panels (GPPs) impact outcomes for individuals with inflammatory bowel disease (IBD)."


Living with inflammatory bowel disease (IBD) means navigating a constant balancing act. Is that abdominal pain a flare-up of your condition, or something else entirely? Gastrointestinal infections can mimic IBD symptoms, making it crucial to identify the true culprit. Traditionally, doctors have relied on stool cultures and specific tests for Clostridium difficile (C. difficile) to diagnose infections in IBD patients. However, a new generation of tests called multiplex gastrointestinal pathogen panels (GPPs) has emerged, promising faster and more comprehensive results. But are these advanced tests truly better for IBD patients?

GPPs detect a wide array of bacteria, viruses, and parasites by identifying their genetic material. They offer several advantages over traditional methods, including speed and the ability to detect multiple pathogens simultaneously. However, GPPs are so sensitive that they can pick up non-viable organisms or remnant genetic material, leading to the detection of pathogens that aren't actually causing illness. This oversensitivity raises concerns about misdiagnosis, unnecessary antibiotic use, and delays in appropriate IBD treatment.

A recent study delved into the real-world impact of GPPs on IBD patients experiencing suspected flare-ups. Researchers compared outcomes for patients who underwent GPP testing versus those who had traditional stool testing. The findings might surprise you.

The GPP Paradox: More Information, Worse Outcomes?

Intestinal path decision tree

The study, published in Digestive Diseases and Sciences, included 268 IBD patients who underwent stool testing for suspected flares between 2012 and 2016. Half of the patients received GPP testing, while the other half underwent conventional stool culture and C. difficile testing. The researchers then compared several outcomes, including hospitalization rates, emergency department (ED) visits, and IBD treatment modifications.

Interestingly, the study revealed that GPPs detected pathogens at a much higher rate than traditional testing (30.6% vs. 10.4%). While this might seem like a clear win for GPPs, the increased detection rate didn't translate to better outcomes for patients. In fact, patients who underwent GPP testing experienced some concerning trends:
  • Higher healthcare utilization: Patients in the GPP group had three times higher odds of IBD-related hospitalization, surgery, or ED visits within 30 days of testing.
  • Less IBD treatment modification: Patients in the GPP group were less likely to have their IBD medications adjusted in response to the test results.
Why did GPPs, which seemingly provided more information, lead to potentially worse outcomes? The researchers believe that the key lies in how the test results were interpreted and acted upon. They found that non-gastroenterologists were more likely to order GPPs than traditional stool testing. This suggests that providers less specialized in IBD might have struggled to interpret the comprehensive results of GPPs, potentially misattributing symptoms to detected pathogens and delaying necessary adjustments to IBD treatment. This delay, coupled with potentially unnecessary antibiotic use, could have contributed to the higher rates of healthcare utilization observed in the GPP group.

Rethinking the Approach to Infections in IBD

This study highlights the importance of carefully considering the implications of new diagnostic technologies. While GPPs offer the allure of comprehensive pathogen detection, they may not always be the best choice for IBD patients. In some cases, sticking with traditional C. difficile testing may be the most prudent approach. When GPPs are used, it's crucial for healthcare providers, especially those less specialized in IBD, to interpret the results cautiously and avoid reflexively prescribing antibiotics for every detected pathogen. A more nuanced approach, focusing on the patient's overall clinical picture and considering the possibility of an IBD flare, is essential to ensure the best possible outcomes.

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