‘I’m a gastroenterologist, and here are four of the most underutilised tests for gut health that I use all the time’

In a recent Instagram video, gastroenterologist Dr Saurabh Sethi highlighted what he believes are some of the most overlooked investigations for gut health. He said, “I’m a gastroenterologist, and here are four of the most underutilised tests for gut health that I use all the time. Number one, the faecal calprotectin simple stool test tells me if there is real inflammation in your gut and not just IBS. Second, celiac disease testing that is TTG IgA misses this, and you can struggle with bloating, fatigue, and nutrient deficiencies for years. Next, the H pylori breath test non-invasively detects the bacteria linked to gastritis, ulcers, and long-term stomach issues, and the last pancreatic stool elastase tells me if you’re actually digesting food properly. Most importantly, fats, and here is what most people miss: you can’t fix your gut if you don’t know what is actually wrong. Comment labs, and I will send you a guide that will show you the most important tests that are required to check your gut health. Trust your gut.”

While these tests are commonly used in gastroenterology, they are not appropriate for everyone with digestive symptoms. Knowing when they are recommended, what they can and cannot diagnose, and how doctors decide which investigation to order is essential for avoiding unnecessary testing while ensuring serious conditions are not overlooked. To better understand their role in evaluating gut health, we asked an expert.

Understanding key gut health tests

Dr Adithya V. Naragund, Senior Consultant in GI & HPB Surgery at Cytecare Hospitals, Bengaluru, tells indianexpress.com, “These tests are valuable because they help distinguish functional digestive disorders from conditions that require targeted treatment.”

He adds:

• Faecal calprotectin is a stool marker of intestinal inflammation. It is particularly useful in differentiating inflammatory bowel disease from irritable bowel syndrome, as IBS does not typically cause intestinal inflammation. It is recommended for people with persistent diarrhoea, abdominal pain, blood in stools, or unexplained weight loss.
• The TTG IgA blood test is the preferred screening test for coeliac disease. Individuals with chronic bloating, diarrhoea, unexplained anaemia, recurrent nutrient deficiencies, or a family history of coeliac disease should be evaluated. It is important that patients continue eating gluten before testing, as eliminating gluten beforehand can produce false negative results.
• The H. pylori breath test is a reliable, non-invasive method to detect an active H. pylori infection, which is associated with gastritis, peptic ulcers, and an increased long-term risk of gastric cancer. It is most appropriate for people with persistent upper abdominal discomfort, recurrent indigestion, or suspected peptic ulcer disease.
• Pancreatic stool elastase measures pancreatic enzyme function and helps identify exocrine pancreatic insufficiency. It is particularly useful in patients with chronic diarrhoea, greasy stools, unintended weight loss, or malabsorption, especially in those with chronic pancreatitis or diabetes.

“These tests should always be selected based on the patient’s symptoms and clinical evaluation rather than being used as routine screening for everyone,” states Dr Naragund.

Self-diagnosis vs medical evaluation

Self-diagnosis has become increasingly common, particularly with the widespread availability of health information on social media. Dr Naragund states that many patients start probiotics, digestive enzymes, or restrictive diets without establishing the underlying cause of their symptoms. “While these approaches may temporarily reduce discomfort in some individuals, they can also delay the diagnosis of conditions that require specific medical treatment.”

He adds that digestive symptoms that persist for more than a few weeks, recur frequently, or progressively worsen should not be ignored. Warning signs include blood in stools, unexplained weight loss, persistent diarrhoea, severe abdominal pain, difficulty swallowing, recurrent vomiting, iron deficiency anaemia, or symptoms that regularly disturb sleep. These features require timely medical evaluation because they may indicate inflammatory, infectious, structural, or even malignant conditions rather than a simple functional disorder.

“The goal is not to perform every available test but to identify the right test based on a careful history, physical examination, and clinical suspicion,” shares Dr Naragund.

When gut symptoms need further investigation

DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.