BlueCross BlueShield of Tennessee Medical Policy Manual

Fecal Analysis in the Diagnosis of Intestinal Disorders


Fecal analysis has been proposed for individuals with various gastrointestinal symptoms (e.g., gas, bloating, abdominal pain) as a method to differentiate intestinal microflora and related immunologic responses that may be related to those symptoms. Fecal analysis purportedly evaluates stool for beneficial bacteria as well as imbalanced gut flora and possible pathogens.

Examples of available tests include the Comprehensive Digestive Stool Analysis (CDSA)™ ( Genova Diagnostics), and SmartGut™ (uBiome, San Francisco, CA). SmartGut™ is marketed as the first sequencing-based clinical microbiome screening test capable of detecting microorganisms that can only be detected by DNA sequencing.




No studies were identified addressing the diagnostic accuracy of fecal analysis verses other standard diagnostic approaches or that compared health outcomes in individuals managed with and without fecal analysis tests.


BlueCross BlueShield Association. Evidence Positioning System. (1:2019). Fecal analysis in the diagnosis of intestinal dysbiosis (2.04.26). Retrieved February 1, 2019 from articles and/or guidelines reviewed)

Emmanuel, A., Landis, D., Peucker, M., & Hungin, A. (2016). Faecal biomarker patterns in patients with symptoms of irritable bowel syndrome. Frontline Gastroenterology, 7 (4), 275-282. (Level 4 evidence)

Goepp, J., Fowler, E., McBride, T., & Landis, D. (2014). Frequency of abnormal fecal biomarkers in irritable bowel syndrome. Global Advances in Health and Medicine, 3 (3), 9-15. (Level 4 evidence)




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