Being told your workup was negative matters — it means the serious causes were excluded. But it isn't the same as knowing why you feel this way, and there's usually more to find.
Some symptoms need conventional workup or a gastroenterologist before any functional evaluation. If any of these apply, that comes first — and I'd rather refer you and be wrong than not.
Timing relative to meals, what improves and worsens it, bowel habit, stress, sleep, antibiotic and medication history. This narrows the possibilities more than any single test.
Celiac serology — accurate only while you're still eating gluten. Thyroid function, iron studies, and inflammatory markers. Each has a defined result and a defined next step.
Stool testing and breath testing for SIBO both have a place when the clinical picture already points that way. Ordering everything available produces data, not answers.
A short structured trial with a clear endpoint beats an open-ended elimination diet. I'd rather you remove two things for four weeks and know, than avoid twenty foods indefinitely and not.
Ongoing care with one provider tracking this over time — longer visits, messaging between them, and continuity as things change.
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Sometimes. Breath testing has real limitations — false positives and negatives are both common — so it's most useful when the clinical picture already points that way and the result would change treatment.
Possibly, but get tested for celiac disease first if you haven't been. Testing is only accurate while you're still eating gluten, so removing it first closes that door for months.
Only if the result would change what we do. For some people it does. For others it produces a long colourful report and no clearer plan. We'd decide together rather than ordering it by default.
Bleeding, unintended weight loss, trouble swallowing, unexplained anemia, a family history of IBD or colon cancer, or new symptoms after age 50 all warrant referral. Those come before functional workup.
They frequently travel together. Malabsorption affects iron and B12, poor sleep from night-time symptoms affects everything, and chronic symptoms are genuinely exhausting. That's why the workup usually looks wider than the gut.
It depends what you're treating. Probiotics have decent evidence for specific situations and weak evidence as a general daily supplement. Strain and dose matter more than the label claim.
Fifteen minutes to talk through your symptoms and what's already been ruled out.