Application area · IBS and IBD

IBS and inflammatory bowel disease: what putting the gut flora in order can do — and what it cannot

Two different diseases, one shared question: does it help if we replace the gut flora? The answer is not the same for the two. In ulcerative colitis several independent randomised trials speak in favour of the treatment; in IBS the picture is contradictory, and the professional guidelines do not currently recommend it. On this page we state both — so that you know where you stand.

Before we begin

What is happening in your body?

If you have lived with it for years, you know: the complaint is real even when the test results are normal.

IBS (irritable bowel syndrome) is the most common functional disorder of the digestive system: abdominal pain, bloating and altered bowel function — with constipation (IBS-C), with diarrhoea (IBS-D) or alternating between the two (IBS-M). There is no visible inflammation or organic change behind it, which is why the diagnosis is often drawn out over years. This does not mean that the complaint is “not real”: the sensitivity of the gut–brain axis, the production of intestinal gases and the composition of the microbiota all differ measurably.

IBD (inflammatory bowel disease) is of a different nature: here there is confirmed, chronic inflammation in the bowel wall. Its two main forms are ulcerative colitis and Crohn's disease. This is a lifelong condition requiring specialist care, in which there is no alternative to drug treatment — microbiota transfer can at most be placed alongside it, never instead of it.

A clarification we often have to make. Coeliac disease (gluten sensitivity) is not an inflammatory bowel disease but a gluten intolerance of autoimmune origin; its treatment is a gluten-free diet. Microscopic colitis is a separate condition with its own treatment regimen. In neither case is there evidence that would support microbiota transfer.

The Dysbiosis can be demonstrated in both diseases: lower species richness, fewer bacteria producing short-chain fatty acids, less Faecalibacterium prausnitzii. Microbiota transfer therapy (MTT) tries to restore this — not by introducing a single strain, but by replacing the whole community. Where this leads to a measurable result and where it does not is stated by the evidence section of this page.

Seven questions

Is this for my case?

This is not a diagnosis and does not replace a medical examination — but in one minute it shows whether it is worth getting in touch with us.

When the next step is not this, but hospital

Severe, acute colitis — six or more bloody stools a day accompanied by fever, rapid heartbeat, anaemia or a raised sedimentation rate —, suspected toxic megacolon, bowel perforation, peritonitis, massive intestinal bleeding, bowel obstruction, an undrained abscess, dehydration or sepsis all require immediate hospital care. In such a case do not contact us: call an ambulance or go to an emergency department.

Likewise, investigation must come first, not treatment, if you have an unexplained alarm symptom: fresh blood in the stool, unintentional weight loss, anaemia, night-time symptoms, symptom onset over the age of 50 or bowel cancer in the family.

Realistic expectations about timing

What to expect, and when

So that you know what happens when and where the decision points are.

Week 0

Registration and the start of the therapy

Recording the patient data, completing the “Goals and expectations” questionnaire, and a telephone consultation if you wish. Once the decision is made, the compatibility test starts — and with it the microbiota transfer, since the test itself is low-dose MTT. The therapy therefore does not begin in week 10, but here.

Week 5

Evaluating the test

We evaluate the test, select the appropriate LOT, fill in the exposome questionnaire together, and dose determination begins. By this point the symptom and food diary also shows which foods and situations trigger the complaints. Decision: whether we move on to finding the therapeutic dose.

Week 10

The therapeutic dose

We determine the dose to be used. MTT has been running at a low dose since the first week; from here on it continues at the therapeutic dose. Decision: whether we move on to the minimum 60-day, full-dose phase with the capsule of the selected LOT number.

Week 18

Assessment, then tapering off

This is where it becomes clear whether the treatment has brought a meaningful change. Decision: can further improvement be expected from continuing, or from changing LOT? If not, we begin tapering off, reducing by one capsule every 7–10 days. If it has not worked, we say so, and we do not recommend continuing.

How the process is built up

Your path step by step

The same order as on the timeline above. At every stage you will know what the next thing to do is.

Getting in touch and pre-screening

Fill in the form or ask for a call back. In a free, 15-minute conversation we clarify whether it makes sense to start in your case. If we see that it does not, we will say so.

Registration and setting goals

We send a link by e-mail with which you can register as a patient. At that point you receive from us a unique identifier in the P0000000 format. We record the patient data, and you fill in the “Goals and expectations” questionnaire.

FindBiome: this is where the therapy starts

The FindBiome is the compatibility test itself: it shows which donor your microbiota matches best, and screens out possible side effects. Since the capsule is low-dose microbiota transfer, the therapy begins with this step. The capsules are assembled within 72 hours. It is a paid step, but it does not oblige you to continue.

Evaluation, LOT selection, exposome

week 5 we evaluate the test and select the appropriate LOT. We fill in the exposome questionnaire together: we review the diet, the lifestyle and the possible environmental exposures. Dose determination begins.

The therapeutic dose and TransferBiome

The week 10 we determine the dose to be used, and the treatment continues at the full, therapeutic dose: minimum 60-day phase with the capsule of the selected LOT number, under the guidance of the treating physician.

Assessment, then tapering off

The symptom and food diary, together with regular consultation, accompanies the whole process. By week 18 we assess the result. If no further improvement can be expected, we taper the capsule off gradually, reducing by one every 7–10 days.

Transparent pricing

What the procedure costs, and when you have to decide

You do not have to decide about the whole process at once. After every step you have the opportunity to assess the results achieved.

StepWhat we providePriceMust you continue?
1. Call back and pre-screeningA 15-minute conversation, clarifying suitabilityfree of chargeno
2. FindBiome compatibility test
4×15 capsules
Testing donor–recipient matching, at the same time low-dose MTT, the first phase of the therapy1,140 €
+ shipping cost
no
3. Exposome consultationAssessment of environmental and lifestyle exposures, setting goals together (with a DynaMAP baseline if wanted)185 €
the DynaMAP can be ordered separately: €325 (professional) or €575 (comprehensive)
no
4. TransferBiome course
60 / 3×60 capsules
Personalised composition, full protocol + follow-up (the quantity required is decided during the biological trial)1,350 €/60 capsules

What the price includes, and what it does not

ItemIncluded?
Call back and pre-screening (15-minute conversation)yes — free of charge
FindBiome compatibility testseparate item: 1,140 €
Exposome consultationseparate item: 185 €
DynaMAP microbiome profilecan be ordered separately: €325 (professional) or €575 (comprehensive)
Appearing in personis not necessary — the process is remote throughout
The capsules in the packaging unit orderedyes — at the price in the table above
Shipping costno — the delivery charge is separate
Follow-up during the courseyes
Joint closing assessment and tapering-off planyes
Examination by the treating physician, laboratory testsno — these take place at your own healthcare provider
The compatibility test is a meaningful step in itself. It shows which of the available donors' microbiota best matches your bacterial matrix. If we do not find a suitable one, we will say so after the test, and we will not recommend continuing. We assemble the capsules within 72 hours of the order, and they are then ready for shipping.
The right treatment

Which capsule is for what?

The same high-quality donor microbiota, processed in a certified laboratory — in two steps, tailored to your situation.

Compatibility test

FindBiome

4×15 capsules
  • Testing donor–recipient compatibility in order to select the best-matching donor — at the same time low-dose microbiota transfer, and therefore the first phase of the therapy
  • A preliminary assessment that underpins the questions of the exposome consultation
  • From €1,140 — a low-risk first step that does not oblige you to continue
  • Minimum order: 1 packaging unit (4×15 capsules)
FindBiome details →
MTT therapy

TransferBiome

60/3×60 capsules
  • The course that follows the compatibility test, with a personalised composition
  • Only under the guidance of the treating physician, with continuous follow-up
  • €1,350 / 60 capsules, or €3,500 / 180 capsules. The capsules are ready for shipping within 72 hours of the order.
  • Following a protocol refined on the basis of the exposome consultation
TransferBiome details →
Evidence

What we know today — in brief

The two diseases are on one page, but they are not in the same weight class. This is the most important sentence to take away from this page. In ulcerative colitis several independent randomised trials speak in favour of microbiota transfer; in IBS the results are contradictory, and the professional guidelines do not currently recommend it.

Ulcerative colitis: four randomised trials, all pointing the same way. The Canadian, the Dutch, the Australian and the Costello trial all showed a higher remission rate in the group receiving donor stool than in the placebo group.371, 796, 392, 188 The size of the effect is nevertheless modest — typically one patient in four or five reaches remission — and the protocols (number of donors, intensity, route of delivery) differ from trial to trial.

Crohn's disease: here there is substantially less data. On the basis of a single smaller French randomised trial and the pooled picture from the systematic reviews, routine use cannot be recommended today.478, 793 If you come to us with Crohn's disease, we say this in advance.

IBS: one strong positive trial, one strong negative one, and cautious guidelines. In a Norwegian trial of 164 patients, 89% of those receiving the 60-gram dose improved, against 23.6% on placebo;390 another Norwegian research group, by contrast, found that placebo performed better.779 According to the three-year follow-up the effect persists, but fades.782 In IBS the guideline of the American College of Gastroenterology does not recommend faecal transplantation in routine care.785

What we can responsibly promise on this basis: nothing. What we do undertake: to tell you which column your case stands in — and if the evidence is weak, to say that it is weak.

Scientific background →

What patients ask most often

Safety you can rely on

Donor screening

Every donor goes through DSQ donor screening framework.

Batch identification

Every capsule we ship carries a LOT number (a manufacturing batch identifier), so it can be traced back to the donor at any time.

Compatibility checked in advance

The FindBiome test shows, before the therapeutic dose, which donor matches, and screens out a preparation that is poorly tolerated. If there is no suitable one, we do not recommend continuing.

Medical supervision throughout

We do not start a protocol without a treating physician. In IBD this is not optional: we work with the knowledge and agreement of the gastroenterologist in charge, and the existing drug treatment continues unchanged.

Follow-up

The symptom and food diary accompanies the whole course. We assess in week 18: if it has not brought a meaningful change, we say so, and we do not recommend continuing.

Known side effects

In the studies, mild, transient complaints are common: bloating, abdominal discomfort, transient diarrhoea or constipation, slightly raised temperature. Serious events are rare. In IBD flare-ups have also been described, which is why we track the inflammatory parameters.

No two cases are the same

The detailed protocol of MTT therapy

The process breaks down into four phases, and at the end of each there is an exit point. We do not build in automatic continuation.

Step 1 — Compatibility test (FindBiome). 4×15 capsules over 32 days: five-day dosing periods with three-day breaks between them. During this time you keep a symptom and food diary, which we analyse at the end and also share with your treating physician. The aim of the test is not a change in your condition: we concentrate on screening out possible side effects and on selecting the donor. Price: €1,140 + shipping cost.

Step 2 — Exposome consultation and DynaMAP (optional). If you would like to understand your own microbiota profile more deeply, we carry out a DynaMAP analysis and you can also take up a consultation. The consultation is €185; DynaMAP can be ordered separately, and the result is ready in 16–20 days. The test requires a whole, homogenised, refrigerated stool sample processed within 4 hours of collection — we send a separate sampling kit for this.

Step 3 — TransferBiome course. On the basis of the compatibility test result, the course continues with the best-matching composition, as a minimum 60-day therapeutic course. We set the daily number of capsules, the diary keeping continues, and the treatment is directed throughout by your treating physician. Price: €1,350 / 60 capsules.

Step 4 — Assessment, gradual tapering, long-term balance. We assess in week 18. If the symptoms have improved to the desired extent, we gradually reduce the daily dose under medical guidance. In this phase the key is a lifestyle that supports the balance achieved: nutrition, exercise, stress management.

What is worth paying attention to during the treatment:
  • Avoid taking antibiotics and probiotics, unless your treating physician advises otherwise.
  • Do not stop your IBD medicines — MTT does not replace them.
  • Eat live-culture, fermented foods regularly — kefir or lacto-fermented vegetables, for example.
  • Choose animal protein free of additives and antibiotics, and avoid artificial sweeteners.
Common questions

What patients usually ask us

Is the treatment the same in IBS and in IBD?
The preparation is the same, the evidence is not. In ulcerative colitis four randomised trials show a higher remission rate than placebo; in IBS the results are contradictory, and the professional guidelines do not recommend routine use. That is why in IBS we recommend starting only when the established routes have already been exhausted — and we say this in advance.
Can I stop my medicines?
No. In IBD the maintenance drug treatment continues: microbiota transfer does not replace it, it complements it. Only the gastroenterologist in charge can decide about stopping a medicine. If anyone promises that the capsule will let you stop your medicine, do not believe it.
Is a treating physician needed?
Yes. In IBD this is not optional: we work with the knowledge and agreement of the gastroenterologist in charge. In IBS, too, a treating physician who follows the process is needed. If you do not have one, we help you find the right specialist — without this we do not start a protocol.
How long does it take to see whether it works?
The compatibility test takes five weeks; the therapeutic dose starts in week 10 and runs for a phase of at least 60 days. The substantive assessment takes place in week 18. If there is no change by then, we say so, and we do not recommend continuing.
What happens if it does not work?
It happens, and not rarely. In the studies a substantial proportion of patients did not respond. There is a decision point in week 5, week 10 and week 18 of the process, and you can stop at any of them. We do not build in automatic repetition.
I have coeliac disease — could this be good for me too?
Coeliac disease is not an inflammatory bowel disease but a gluten intolerance of autoimmune origin, whose proven treatment is a strict gluten-free diet. For microbiota transfer in coeliac disease there is today no evidencethat would support it — which is why we do not recommend it. If IBS-like symptoms remain even on a gluten-free diet, that is worth talking about.
Is this safe?
Mild, transient complaints are common: bloating, abdominal discomfort, transient diarrhoea or constipation, slightly raised temperature. Serious events are rare, but flare-ups have also been described in IBD, which is why we track the inflammatory parameters. In immunosuppressed patients the risk requires individual assessment.
Where does the donor material come from and how is it screened?
Every donor goes through our DSQ donor screening framework: bacteriological, virological, parasitological and serological testing, a stool test and detailed medical-history screening. After the donation the donor is followed by at least eight weeks of quarantine, and we release the preparation only once the results of the repeat tests have arrived. Every capsule shipped can be traced by its LOT number.
What is FindBiome, and why is it a paid step?
FindBiome is the compatibility test: it shows which donor your microbiota matches best, and screens out a preparation that is poorly tolerated. Since the capsule is low-dose microbiota transfer, this is already the first phase of the therapy — which is why it is paid for. At the same time it does not oblige you to continue: if the test shows that there is no suitable donor, we will say so.
What is the smallest quantity that can be ordered?
For the FindBiome compatibility test, 1 packaging unit (4×15 capsules). For the TransferBiome course, 60 capsules; the 3×60-capsule pack is available at a more favourable unit price.
How long does the whole process take from applying?
The call back happens within 1–2 working days. We assemble the capsules ordered within 72 hours and hand them over to the courier service ready for shipping. The full protocol, from applying to tapering off, typically takes 5–6 months.
What is the legal and regulatory background?
In IBS and inflammatory bowel disease, microbiota transfer therapy is not a guideline recommendation, and in Hungary it is not an authorised medicinal product: we provide the service within individual care directed by a treating physician. We deliver the capsules under the “to the doctor's hand” system; the decision to use them rests in every case with the treating physician. This service is not a substitute for professional medical advice, diagnosis or treatment.

More questions

Documents

Downloadable materials

For treating physicians

If you are a treating physician, or the patient asks you for an opinion: treatment follows the MTT Clinical Protocol Guide v7.1 which sets out patient selection, dose determination, the rules of escalation and gradual tapering, donor screening requirements and the follow-up steps. Referring a patient requires no separate agreement: a single message is enough and we will initiate the professional consultation.

Clinical Protocol Guide v7.1Professional consultation →

The evidence in detail

The scientific background page works through, aspect by aspect and in parallel for both diseases, what the studies measured, what came out, where the uncertainty lies and what the alternative is. Beside every statement stands the reference and its summary.

Scientific background →

Get in touch

Let us talk about your symptoms

Write briefly about the diagnosis you are being treated for, how long the symptoms have lasted, and what has been tried so far. We will review whether it makes sense to start in your case — and if we see that it does not, we will say so.

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MicroBiome Bank does not sell products; it connects donors and recipients by providing professional medical services: it organises the recruitment of donors and their screening in a certified laboratory, the stool tests, and the processing of the screened donation into capsule form. The contents of the capsules remain the property of the donor until the recipient has paid in full. The brand names of the services serve to make them easier to remember. We deliver the capsules “to the doctor's hand”, and they are to be used under the guidance of a treating physician. For detailed information, please contact us.

The MicroBiome Bank service is not a substitute for professional medical advice, diagnosis or treatment. The decision to use it rests in every case with the treating physician.