Bile and the StoolOMX Panel - Patient Case With GI‑MAP Plus StoolOMX

By Ilana Gurevich, ND, NSOM, FABNG

Posted On November 19th, 2025

We're going to look at using the GI-MAP® with StoolOMX™ add-on via a patient case.

So, meet Jenny. Jenny came in with a pretty significant history of diarrhea. In 1999, she had severe food poisoning while living abroad in Central America, and since then, she had persistent diarrhea.

In 2007, she was diagnosed with a positive SIBO test. She was treated with antibiotics, and she had some relief, but it didn't really last. Between 2008 and 2023, she had recurrent flares of bloating, bowel urgency, and watery stools somewhere between a Bristol 6 and a Bristol 7 that was often triggered by travel and antibiotics.

Between 2016 and 2021, she had a very significant worsening of symptoms. She at that point was living in Pakistan and she developed severe digestive distress and an autoimmune-like presentation.

Between 2022 and 2023, she had episodes of foul smelling gas and bloating and diarrhea. She had a GI-MAP that was positive for Blastocystis homminis, and then currently she came in at two loose bowel movements a day, Bristle 5 to Bristle 6 that improved after having colonoscopy prep, and then began to worsen again.

Watch the video to see Jenny's results and the actions taken to treat her.

Author Ilana Gurevich, ND, NSOM, FABNG

Dr. Gurevich is a naturopathic medical physician and an acupuncturist who uses individualized natural therapies to address the underlying cause of disease. She encourages her patients to take an active role in their own health care. Dr. Gurevich relies on a variety of natural modalities including Chinese and Western herbal medicine, acupuncture, nutritional supplements, homeopathy, hydrotherapy, and dietary education.

The opinions expressed in this presentation are the author's own. Information is provided for informational purposes only and is not meant to be a substitute for personal advice provided by a doctor or other qualified health care professional. Patients should not use the information contained herein for diagnosing a health or fitness problem or disease. Patients should always consult with a doctor or other health care professional for medical advice or information about diagnosis and treatment.

Citations

Hundt M, Basit H, John S. Physiology, Bile Secretion. [Updated 2022 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470209/
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Bile Acids. [Updated 2017 Sep 25]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548626/
Chen I, Cassaro S. Physiology, Bile Acids. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549765/#
Hofmann AF. The Continuing Importance of Bile Acids in Liver and Intestinal Disease. Arch Intern Med. 1999;159(22):2647–2658. doi:10.1001/archinte.159.22.2647
Xiang, J., Zhang, Z., Xie, H., Zhang, C., Bai, Y., Cao, H., … Su, Z. (2021). Effect of different bile acids on the intestine through enterohepatic circulation based on FXR. Gut Microbes, 13(1). https://doi.org/10.1080/19490976.2021.1949095
Cai JS, Chen JH. The mechanism of enterohepatic circulation in the formation of gallstone disease. J Membr Biol. 2014 Nov;247(11):1067-82. doi: 10.1007/s00232-014-9715-3. Epub 2014 Aug 9. PMID: 25107305; PMCID: PMC4207937.
Mertens KL, Kalsbeek A, Soeters MR, Eggink HM. Bile Acid Signaling Pathways from the Enterohepatic Circulation to the Central Nervous System. Front Neurosci. 2017 Nov 7;11:617. doi: 10.3389/fnins.2017.00617. PMID: 29163019; PMCID: PMC5681992.
Wang Y, Xu H, Zhou X, Chen W, Zhou H. Dysregulated bile acid homeostasis: unveiling its role in metabolic diseases. Med Rev (2021). 2024 Jun 4;4(4):262-283. doi: 10.1515/mr-2024-0020. PMID: 39135605; PMCID: PMC11317083.
Copple BL, Li T. Pharmacology of bile acid receptors: Evolution of bile acids from simple detergents to complex signaling molecules. Pharmacol Res. 2016 Feb;104:9-21. doi: 10.1016/j.phrs.2015.12.007. Epub 2015 Dec 17. PMID: 26706784; PMCID: PMC4900180.
Jia F, Liu X, Liu Y. Bile acid signaling in skeletal muscle homeostasis: from molecular mechanisms to clinical applications. Front Endocrinol (Lausanne). 2025 Mar 12;16:1551100. doi: 10.3389/fendo.2025.1551100. PMID: 40144297; PMCID: PMC11936799.
Shi L, Jin L, Huang W. Bile Acids, Intestinal Barrier Dysfunction, and Related Diseases. Cells. 2023 Jul 19;12(14):1888. doi: 10.3390/cells12141888. PMID: 37508557; PMCID: PMC10377837.
Ghallab A, Mandorfer M, Stirnimann G, Geyer J, Lindström E, Luedde T, van der Merwe S, Rashidi-Alavijeh J, Schmidt H, Karpen SJ, Fickert P, Trauner M, Hengstler JG, Dawson PA. Enteronephrohepatic circulation of bile acids and therapeutic potential of systemic bile acid transporter inhibitors. J Hepatol. 2025 May 23:S0168-8278(25)02207-X. doi: 10.1016/j.jhep.2025.05.009. Epub ahead of print. PMID: 40414504.
Sun L, Li F, Tan W, Zhao W, Li Y, Zhu X, Gao P, Shu G, Wang S, Jiang Q, Wang L. Lithocholic acid promotes skeletal muscle regeneration through the TGR5 receptor. Acta Biochim Biophys Sin (Shanghai). 2023 Jan 25;55(1):51-61. doi: 10.3724/abbs.2022201. PMID: 36647725; PMCID: PMC10157625.
Cheng L, Chen T, Guo M, Liu P, Qiao X, Wei Y, She J, Li B, Xi W, Zhou J, Yuan Z, Wu Y, Liu J. Glycoursodeoxycholic acid ameliorates diet-induced metabolic disorders with inhibiting endoplasmic reticulum stress. Clin Sci (Lond). 2021 Jul 30;135(14):1689-1706. doi: 10.1042/CS20210198. PMID: 34236076; PMCID: PMC8302808.
Fleishman JS, Kumar S. Bile acid metabolism and signaling in health and disease: molecular mechanisms and therapeutic targets. Signal Transduct Target Ther. 2024 Apr 26;9(1):97. doi: 10.1038/s41392-024-01811-6. PMID: 38664391; PMCID: PMC11045871.
Zhang X, Liu X, Yang J, Ren F, Li Y. Quantitative Profiling of Bile Acids in Feces of Humans and Rodents by Ultra-High-Performance Liquid Chromatography-Quadrupole Time-of-Flight Mass Spectrometry. Metabolites. 2022 Jul 11;12(7):633. doi: 10.3390/metabo12070633. PMID: 35888757; PMCID: PMC9323729.
Foley MH, O'Flaherty S, Allen G, Rivera AJ, Stewart AK, Barrangou R, Theriot CM. Lactobacillus bile salt hydrolase substrate specificity governs bacterial fitness and host colonization. Proc Natl Acad Sci U S A. 2021 Feb 9;118(6):e2017709118. doi: 10.1073/pnas.2017709118. PMID: 33526676; PMCID: PMC8017965.
Cai T, Song X, Xu X, Dong L, Liang S, Xin M, Huang Y, Zhu L, Li T, Wang X, Fang Y, Xu Z, Wang C, Wang M, Li J, Zheng Y, Sun W, Li L. Effects of plant natural products on metabolic-associated fatty liver disease and the underlying mechanisms: a narrative review with a focus on the modulation of the gut microbiota. Front Cell Infect Microbiol. 2024 Feb 20;14:1323261. doi: 10.3389/fcimb.2024.1323261. PMID: 38444539; PMCID: PMC10912229.
McMillan AS, Foley MH, Perkins CE, Theriot CM. Loss of Bacteroides thetaiotaomicron bile acid altering enzymes impact bacterial fitness and the global metabolic transcriptome. bioRxiv [Preprint]. 2023 Jun 27:2023.06.27.546749. doi: 10.1101/2023.06.27.546749. Update in: Microbiol Spectr. 2024 Jan 11;12(1):e0357623. doi: 10.1128/spectrum.03576-23. PMID: 37425690; PMCID: PMC10327073.
Candida Slide - Thangamani S, Monasky R, Lee JK, Antharam V, HogenEsch H, Hazbun TR, Jin Y, Gu H, Guo GL. Bile Acid Regulates the Colonization and Dissemination of Candida albicans from the Gastrointestinal Tract by Controlling Host Defense System and Microbiota. J Fungi (Basel). 2021 Nov 30;7(12):1030. doi: 10.3390/jof7121030. PMID: 34947012; PMCID: PMC8708873.
Larabi AB, Masson HLP, Bäumler AJ. Bile acids as modulators of gut microbiota composition and function. Gut Microbes. 2023 Jan-Dec;15(1):2172671. doi: 10.1080/19490976.2023.2172671. PMID: 36740850; PMCID: PMC9904317.
Olyaiee, A., Sadeghi, A., Yadegar, A., Mirsamadi, E. S., & Mirjalali, H. (2022). Gut microbiota shifting in irritable bowel syndrome: The mysterious role of Blastocystis sp. Frontiers in Medicine, 9, Article 890127. https://doi.org/10.3389/fmed.2022.890127