The Starnberg Method – Bidirectional Fecal Microbiota Transfer (bFMT)

Advanced fecal microbiota transplantation in Starnberg, near Munich, Germany

Fecal microbiota transplantation (FMT), also called fecal microbiota transfer, microbiota transfer or stool transplantation, is a medical procedure designed to restore a disturbed intestinal microbial ecosystem by transferring carefully screened donor microbiota to a recipient.

At the Center for Endoscopy Starnberg, we have developed and clinically evaluated a structured approach known as the Starnberg Method or bidirectional fecal microbiota transfer (bFMT). The method combines carefully selected donor material with standardized preparation and simultaneous administration through the upper and lower gastrointestinal tract.

The strongest evidence for FMT currently exists for recurrent Clostridioides difficile infection (CDI). FMT is also being investigated for conditions such as IBS, SIBO, inflammatory bowel disease and other disorders associated with intestinal microbial alterations. For these indications, the evidence is substantially less established and treatment must be considered individually.

Request a medical consultation

Patients travelling from abroad or from a distance can arrange a video consultation before travelling to Starnberg.

Video consultation:
telemed@internistenzentrum.de

Please include your name, telephone number, country of residence, diagnosis, previous treatments and the reason for your enquiry.

More information on bFMT on the FMT on the german language pillar page.

Medizinisch geprüft von Prof. Dr. Martin Storr, Facharzt für Innere Medizin und Gastroenterologie. Update 28.9.2026

Prof. Dr. Martin Storr ist nationaler und internationaler Experte zu den Themen FODMAP (PMID34891206, PMID30542869, PMID27119689, PMID2490888), Reizdarm (PMID39589118, PMID22783191, PMID41991876), Stuhltransplantation (PMID33744169, PMID37187187), Herausgeber von medizinischen Leitlinien (PMID42095009, PMID28507746) und Autor von zahlreichen Sachbüchern.

What is Fecal Microbiota Transplantation?

Fecal microbiota transplantation is the transfer of a processed preparation of microorganisms originating from a carefully screened healthy donor into the gastrointestinal tract of another person.

The objective is not simply to introduce individual bacteria. Rather, FMT aims to introduce a complex microbial community and thereby support restoration of intestinal microbial diversity and function.

FMT is sometimes called:

Fecal Microbiota Transplantation
Fecal Microbiota Transfer
FMT
Stool transplantation
Stool transplant
Microbiota transplantation
Fecal microbiome transfer
Gut microbiome transplantation
Microbiota replacement therapy

The term stool transplant is widely used by patients, while fecal microbiota transplantation (FMT) is the medical term most commonly used in scientific literature.

Why FMT?

The intestinal microbiome plays an important role in digestion, metabolism, colonization resistance, immune regulation and intestinal barrier function.

Antibiotics, infections, gastrointestinal diseases, altered intestinal motility and other factors can profoundly change the intestinal microbial ecosystem.

FMT attempts to address this ecological disturbance by transferring a complex microbial community rather than targeting a single microorganism.

The clinical evidence is strongest for recurrent Clostridioides difficile infection, where FMT has demonstrated high rates of sustained clinical resolution.

The Starnberg Method: Bidirectional Fecal Microbiota Transfer

What makes bFMT different?

The Starnberg Method is a structured form of bidirectional fecal microbiota transfer (bFMT) developed at the Center for Endoscopy Starnberg.

Instead of administering the microbiota preparation exclusively through one gastrointestinal route, bFMT combines:

Upper gastrointestinal administration + lower gastrointestinal administration within the same treatment concept.

The Starnberg Method – a scientifically evaluated bidirectional FMT approach

A retrospective case-control study involving the German Clinical Microbiome Study Group reported a 100% primary cure rate at day 30 and day 90 following bidirectional FMT, compared with 81.3% for lower-GI administration, 62.5% for upper-GI administration and 78.1% for capsule administration in the matched comparison groups.

These results are particularly relevant to the Starnberg Method because the Center for Endoscopy Starnberg was one of the participating centers and Prof. Martin Storr and Dr. Herbert Eisenlohr were among the authors. However, the study was observational and retrospective; the authors explicitly stated that prospective confirmation is required.

PMID: 33744169

FMT Methods: Which Routes Are Available?

FMT can be administered using different routes. The appropriate method depends on the indication, anatomy, medical history and treatment objective.

FMT method	How it is performed	Main considerations
Bidirectional FMT (bFMT)	Upper + lower gastrointestinal administration	Starnberg Method; studied in recurrent CDI
Colonoscopy FMT	Microbiota preparation administered during colonoscopy	Direct delivery to the colon
Upper GI FMT	Administration through gastroscopy or duodenal route	Alternative delivery route
Capsule FMT	Encapsulated microbiota swallowed orally	Non-endoscopic option
Enema FMT	Administration through the rectum	Primarily lower-GI delivery
Nasogastric/nasojejunal FMT	Administration through a feeding tube	Used in selected settings

Studies comparing administration routes have found high efficacy for several methods, with colonoscopic delivery demonstrating particularly high cure rates in recurrent CDI. The optimal route should nevertheless be selected according to the individual clinical situation rather than simply choosing one route for every patient.

PMID: 32166622; PMID: 33437951

Why We Use the Starnberg bFMT Approach

The Starnberg Method was developed around the principle that FMT is not simply a matter of transferring stool.

The quality of the treatment depends on the entire chain:

Donor → screening → preparation → administration → follow-up

Our bFMT concept therefore places particular emphasis on:

1. Donor quality

Donors undergo medical assessment and microbiological screening designed to reduce the risk of transmission of infectious agents.

2. Standardized preparation

The donor material is prepared according to a defined medical protocol.

3. Bidirectional delivery

The Starnberg Method combines upper and lower gastrointestinal administration in the same treatment concept.

4. Medical supervision

FMT is performed within a gastroenterological environment with endoscopic expertise.

5. Follow-up

The clinical response and further treatment requirements are assessed after the procedure.

FMT for Recurrent Clostridioides difficile Infection

The best-established indication for FMT

The strongest clinical evidence for fecal microbiota transplantation exists for recurrent Clostridioides difficile infection.

C. difficile can cause severe diarrhea and colitis, particularly after antibiotic treatment. Recurrent disease can become a cycle of repeated antibiotic treatment followed by further disruption of the intestinal microbiome.

FMT takes a different therapeutic approach: rather than targeting C. difficile alone, it aims to restore the microbial ecosystem and intestinal colonization resistance.

Randomized clinical trials and large systematic reviews have demonstrated high rates of sustained cure for recurrent CDI.

In a landmark randomized trial, donor fecal microbiota restored clinical cure in 81% of patients after a first treatment and 94% after repeat treatment.

PMID: 23323867

A subsequent meta-analysis found an approximately 84% clinical effect after single FMT and 91% after repeat FMT at eight weeks.

PMID: 33437951

The 2024 American Gastroenterological Association guideline recommends selected fecal microbiota-based therapies for adults with recurrent C. difficile infection after completion of standard-of-care antibiotics.

PMID: 38395525

FMT for IBS – Irritable Bowel Syndrome

Irritable bowel syndrome is associated in some patients with alterations of the intestinal microbiome, intestinal barrier function, immune signaling and gut-brain interaction.

FMT has therefore been investigated as a potential microbiome-directed treatment for IBS.

Randomized trials and meta-analyses have reported improvements in IBS symptoms in some study populations. However, results have been heterogeneous and depend on donor characteristics, administration route, treatment protocol and patient selection.

Importantly, the 2024 AGA guideline does not recommend conventional FMT for routine treatment of IBS outside clinical trials.

At the Center for Endoscopy Starnberg, patients with IBS therefore receive an individual assessment rather than an automatic recommendation for FMT.

PMID: 37275867; PMID: 37667968; PMID: 38395525

FMT for SIBO

Small Intestinal Bacterial Overgrowth

SIBO describes excessive bacterial colonization of the small intestine and can be associated with bloating, abdominal pain, diarrhea and other gastrointestinal symptoms.

FMT has been studied as a potential microbiome-modulating treatment for SIBO. A randomized placebo-controlled clinical trial involving 55 patients reported improvements in gastrointestinal symptoms and microbiome diversity after FMT.

However, the evidence remains insufficient to establish FMT as standard eradication therapy for SIBO.

Current consensus recommendations emphasize appropriate diagnosis and test-directed treatment. FMT is not currently recommended as primary routine eradication therapy for SIBO.

PMID: 33549047; PMID: 42434160

FMT for IMO

Intestinal Methanogen Overgrowth

IMO is characterized by increased methane production by methanogenic archaea in the gastrointestinal tract. It is commonly associated with constipation, bloating and altered intestinal transit.

Unlike SIBO, IMO is not caused primarily by bacteria.

Hydrogen and methane breath testing can help characterize suspected SIBO or IMO.

There is currently insufficient clinical evidence to recommend FMT as a standard treatment for IMO. Patients with suspected IMO should therefore receive an individualized diagnostic and therapeutic assessment.

FMT for Dysbiosis

Can FMT treat „gut dysbiosis“?

The term dysbiosis describes an alteration of the intestinal microbial ecosystem. It is not, by itself, a single disease diagnosis.

Changes in the microbiome can occur in many gastrointestinal and systemic conditions. However, the presence of an abnormal microbiome test does not automatically mean that FMT is medically indicated.

FMT should therefore not be offered simply because a commercial microbiome test reports „dysbiosis“.

Instead, the underlying clinical diagnosis, symptoms, previous treatments and scientific evidence for FMT should be evaluated.

FMT for Auto-Brewery Syndrome

Endogenous alcohol production

Auto-Brewery Syndrome, also called gut fermentation syndrome, is a rare condition in which microorganisms produce ethanol within the gastrointestinal tract.

FMT has been reported in individual cases and is being investigated as a possible microbiome-directed treatment.

A recent case report described FMT in a patient with longstanding Auto-Brewery Syndrome, while a 2026 observational study reported extensive microbiome and microbial ethanol-production abnormalities in affected patients.

However, the evidence remains limited and FMT cannot currently be considered an established standard therapy for Auto-Brewery Syndrome.

PMID: 39647535; PMID: 41507585

Other Conditions Investigated With FMT

FMT and microbiome-based therapies are being studied in a growing number of conditions, including:

Ulcerative colitis
Crohn’s disease
Pouchitis
IBS
SIBO
Chronic constipation
Metabolic syndrome
Liver disease
Auto-Brewery Syndrome
Other microbiome-associated disorders

Some of these conditions have promising clinical trial data, but evidence quality varies substantially.

For inflammatory bowel disease, for example, recent meta-analyses suggest potential benefit in selected patients with ulcerative colitis, but current professional guidelines still do not regard conventional FMT as routine treatment outside appropriate clinical contexts.

PMID: 40246750; PMID: 38395525

How Does FMT Work?

The therapeutic effect of FMT is thought to involve several mechanisms.

Microbial restoration

FMT can introduce a diverse community of microorganisms into the recipient’s intestine.

Colonization resistance

A healthy intestinal microbial ecosystem can inhibit the expansion of pathogenic organisms.

Metabolic effects

Gut microorganisms produce metabolites such as short-chain fatty acids and influence bile acid metabolism and other pathways.

Immune interaction

The microbiome interacts continuously with the intestinal immune system and epithelial barrier.

Ecological restoration

The overall concept is therefore not simply „adding good bacteria“, but attempting to restore a more functional microbial ecosystem.

Donor Screening and Safety

Why donor screening is essential

FMT involves the transfer of biological material from one person to another. Consequently, donor selection and microbiological screening are central components of safe treatment.

International consensus recommendations include extensive blood and stool testing for potentially transmissible infectious agents.

The FDA has reported serious infections caused by transmission of multidrug-resistant organisms and pathogenic bacteria following inadequately screened FMT material. These reports underline why FMT should be performed only within a medically controlled setting with appropriate donor screening and quality assurance.

PMID: 31210950

Is FMT Safe?

For appropriately selected patients with recurrent CDI, large clinical datasets support a generally favorable safety profile.

A systematic review and meta-analysis of 61 studies involving more than 5,000 patients found that serious adverse events attributable to FMT occurred in less than 1%, while minor gastrointestinal symptoms were generally self-limited.

Possible short-term symptoms include:

Bloating
Abdominal discomfort
Nausea
Temporary changes in bowel movements
Diarrhea or constipation

Rare but important risks include infection transmission and complications associated with the route of administration, including endoscopic complications.

PMID: 35479587

Your FMT Treatment in Starnberg

A structured process

Step 1 – Initial medical assessment

We first determine whether FMT is medically appropriate for your diagnosis.

Previous laboratory results, endoscopy reports, microbiological tests, medication history and previous therapies can be reviewed.

Step 2 – Video consultation if required

Patients travelling from abroad or from another region can first arrange a video consultation.

Email: telemed@internistenzentrum.de

This allows the medical team to assess the indication before you travel to Germany.

Step 3 – Donor and microbiological assessment

Appropriate donor material undergoes medical and microbiological quality control.

Step 4 – Treatment planning

The appropriate FMT route is selected according to your diagnosis and individual circumstances.

Where clinically appropriate, the Starnberg Method uses bidirectional FMT.

Step 5 – FMT treatment

The microbiota preparation is administered under medical supervision.

Step 6 – Follow-up

Clinical response and further treatment requirements are assessed after FMT.

FMT in Starnberg, Germany – Convenient for International Patients

The Center for Endoscopy is located at:

Zentrum für Endoskopie
Oßwaldstraße 1
PoliCenter
82319 Starnberg
Germany

Starnberg is located southwest of Munich and can be reached from Munich Airport and central Munich.

For patients travelling from abroad, we recommend arranging the medical assessment by video consultation before travelling.

International FMT enquiries

telemed@internistenzentrum.de

Please provide:

Full name
Telephone number
Country of residence
Diagnosis
Number of previous C. difficile episodes, if applicable
Previous antibiotic treatments
Previous FMT, if applicable
Relevant medical reports
Preferred dates for travel

Frequently Asked Questions About Fecal Microbiota Transplantation

1. What is fecal microbiota transplantation?

Fecal microbiota transplantation (FMT) transfers processed intestinal microbiota from a carefully screened donor to a recipient with the aim of restoring microbial function. It is also commonly called a stool transplant or fecal microbiota transfer.

PMID: 38395525

2. Is FMT the same as a stool transplant?

Yes. „Stool transplant“ is the patient-friendly term, while fecal microbiota transplantation is the medical and scientific term. The treatment involves transferring processed donor-derived microbiota rather than simply transferring untreated stool.

PMID: 37187187 – PubMed

3. What is FMT used for?

The strongest evidence is for preventing recurrence of Clostridioides difficile infection after appropriate antibiotic treatment. Other conditions such as IBS, SIBO and inflammatory bowel disease are being investigated, but the evidence and recommendations differ considerably.

PMID: 38395525 – PubMed

4. Is FMT effective for recurrent C. difficile infection?

Yes. FMT has demonstrated high cure rates in recurrent CDI, with systematic reviews reporting approximately 84% clinical effect after a single treatment and around 91% after repeat treatment at eight weeks.

PMID: 33437951

5. How successful is FMT after one treatment?

Results vary according to patient population, treatment route and definition of cure. A major meta-analysis reported approximately 84% clinical effect after a single FMT for recurrent CDI.

PMID: 33437951

6. Can FMT be repeated?

Yes. Repeat treatment may be used when clinically appropriate, and meta-analyses show higher cure rates following repeated FMT in recurrent CDI.

PMID: 33437951

7. What is the Starnberg Method?

The Starnberg Method is a structured approach to FMT developed at the Center for Endoscopy Starnberg and incorporates bidirectional administration, donor screening, standardized preparation and follow-up. Its clinical effectiveness was evaluated in a retrospective case-control study.

PMID: 33744169

8. What is bidirectional FMT or bFMT?

Bidirectional FMT combines upper and lower gastrointestinal administration of the microbiota preparation within the same treatment concept. In the Starnberg study, bFMT was associated with 100% primary cure at days 30 and 90, although prospective confirmation is still required.

PMID: 33744169

9. Is the Starnberg Method scientifically studied?

Yes. The Starnberg Method’s bidirectional approach was evaluated in a multicenter retrospective case-control study involving the German Clinical Microbiome Study Group. The authors reported significantly higher primary cure rates with bFMT than with the matched comparison approaches.

PMID: 33744169 – PubMed

10. Is FMT better than antibiotics for recurrent C. difficile?

FMT has demonstrated higher sustained cure rates than conventional antibiotic therapy in several studies of recurrent CDI. For example, a randomized trial found FMT superior to fidaxomicin in the studied population.

PMID: 30610862 – PubMed

11. Can FMT prevent another C. difficile recurrence?

Yes. Prevention of further recurrence is the principal clinical objective of microbiota-based therapy in recurrent CDI. The 2024 AGA guideline supports selected fecal microbiota-based therapies after standard antibiotic treatment.

PMID: 38395525 – PubMed

12. Can FMT treat an initial C. difficile infection?

FMT is primarily established for recurrent CDI rather than uncomplicated first episodes. Initial CDI should be managed according to current evidence-based antimicrobial treatment recommendations, with microbiota-based therapy considered in selected recurrent or severe cases.

PMID: 34678515 – PubMed

13. Can FMT treat severe C. difficile infection?

Conventional FMT may be considered in selected hospitalized patients with severe or fulminant CDI that does not respond adequately to standard therapy. This is a specialist decision requiring individual assessment.

PMID: 38395525 – PubMed

14. How is FMT administered?

FMT can be delivered by colonoscopy, upper gastrointestinal endoscopy, capsules, enemas or nasogastric/nasojejunal routes. The appropriate route depends on the indication and individual patient factors.

PMID: 32166622 – PubMed

15. Is colonoscopy a good way to perform FMT?

Colonoscopy provides direct access to the colon and has demonstrated high cure rates in recurrent CDI. Meta-analysis has found colonoscopic FMT highly effective and comparable with capsule-based approaches in the available evidence.

PMID: 32166622 – PubMed

16. Can FMT be taken as capsules?

Yes. Encapsulated microbiota preparations have been studied extensively and can provide a non-endoscopic administration route. In recurrent CDI, capsule-based approaches have demonstrated high clinical efficacy.

PMID: 34484424 – PubMed

17. Is FMT painful?

The experience depends on the administration route and whether endoscopy or sedation is used. Gastrointestinal symptoms such as temporary bloating or abdominal discomfort can occur after FMT.

PMID: 35479587 – PubMed

18. What are the side effects of FMT?

Temporary bloating, abdominal discomfort, nausea and altered bowel movements can occur. Serious FMT-attributable adverse events were uncommon in a systematic review of more than 5,000 patients with CDI.

PMID: 35479587

19. Can FMT transmit infections?

Yes. Because FMT transfers biological material, infectious transmission is a potential risk. Rigorous donor screening and microbiological testing are therefore essential.

PMID: 31210950 – PubMed

20. How are FMT donors screened?

Donor screening includes medical history, risk assessment and laboratory testing of blood and stool for relevant infectious agents. International consensus recommendations emphasize extensive screening before donation.

PMID: 31210950 – PubMed

21. Can FMT treat IBS?

FMT has been investigated in randomized trials of IBS and some studies report symptom improvement. However, the evidence remains heterogeneous and the 2024 AGA guideline recommends conventional FMT for IBS only in the context of clinical trials.

PMID: 37275867; PMID: 38395525 – PubMed

22. Does FMT help IBS with diarrhea?

Some randomized studies have investigated FMT specifically in diarrhea-predominant IBS. Results vary according to the donor, route and protocol, so FMT should not currently be regarded as routine treatment for IBS-D.

PMID: 37667968

23. Can FMT treat SIBO?

FMT has been studied in SIBO, including a randomized placebo-controlled study reporting symptom improvement. Nevertheless, current consensus guidance considers the evidence insufficient for FMT to be primary routine eradication therapy for SIBO.

PMID: 33549047; PMID: 42434160 – PubMed

24. Can FMT treat methane-positive SIBO or IMO?

IMO is associated with methane-producing archaea rather than simply bacterial overgrowth. Current evidence does not establish FMT as standard therapy for IMO, and diagnostic assessment should include appropriate hydrogen and methane breath testing.

PMID: 42434160 – PubMed

25. Can FMT cure intestinal dysbiosis?

„Dysbiosis“ describes an altered microbial ecosystem rather than one specific disease. FMT should therefore not be prescribed solely because a microbiome test reports dysbiosis; the underlying clinical condition and evidence for treatment must be considered.

PMID: 38395525 – PubMed

26. Can FMT help chronic constipation?

FMT has been investigated in chronic constipation and microbiome-associated bowel disorders. Evidence remains insufficient for FMT to be considered a standard first-line treatment for chronic constipation.

PMID: 39194187 – PubMed

27. Can FMT treat ulcerative colitis?

Randomized trials and recent meta-analyses suggest that FMT may increase remission rates in selected patients with ulcerative colitis. However, treatment remains specialized and should not replace established IBD therapies without appropriate medical assessment.

PMID: 40246750 – PubMed

28. Can FMT treat Crohn’s disease?

FMT has been studied in Crohn’s disease and meta-analyses suggest possible clinical benefit. However, evidence remains heterogeneous and FMT is not established as routine standard therapy for Crohn’s disease.

PMID: 33759066 – PubMed

29. Can FMT treat Auto-Brewery Syndrome?

FMT has been reported in individual Auto-Brewery Syndrome cases and is being investigated as a microbiome-directed treatment. Current evidence remains very limited, so it should be regarded as an individualized or investigational option rather than established standard treatment.

PMID: 39647535 – PubMed

30. What is Auto-Brewery Syndrome?

Auto-Brewery Syndrome is a rare disorder in which intestinal microorganisms produce ethanol after carbohydrate consumption, potentially resulting in endogenous alcohol exposure. Microbiome disturbances and ethanol-producing bacteria or fungi have been implicated.

PMID: 33887125; PMID: 41507585 – PubMed

31. How quickly does FMT work?

For recurrent CDI, clinical improvement can occur rapidly after successful treatment, particularly with resolution of diarrhea. The exact timing varies between individuals and should not be interpreted as evidence of microbiome normalization occurring immediately.

PMID: 23323867 – PubMed

32. How long does an FMT procedure take?

The procedure itself may be relatively short, but the total visit depends on preparation, the chosen administration route, endoscopy and sedation requirements. Patients should therefore plan for the complete clinical appointment rather than only the administration time.

PMID: 32166622 – PubMed

33. Do I need a colonoscopy for FMT?

Not necessarily. FMT can be administered using several routes, including capsules and upper or lower gastrointestinal administration. The most appropriate method is determined by the clinical indication and patient factors.

PMID: 32166622 – PubMed

34. Can FMT be performed as an outpatient procedure?

Selected FMT procedures can be performed in an ambulatory setting, depending on the patient’s condition, indication, administration route and sedation requirements. Patients with severe or complicated CDI may require hospital-based treatment.

PMID: 27658471 – PubMed

35. Is FMT available in Germany?

Yes. FMT is performed at specialized medical centers in Germany, particularly for recurrent C. difficile infection. German registry and multicenter data document its clinical use and outcomes.

PMID: 37187187 – PubMed

36. Can international patients receive FMT in Starnberg?

International patients can first arrange a medical video consultation to discuss their case and whether an in-person assessment is appropriate. The Center for Endoscopy Starnberg provides video consultations for patients travelling from abroad or from a distance.

Video consultation: telemed@internistenzentrum.de

37. Can I have a video consultation before travelling to Germany?

Yes. Patients with a long journey or patients travelling internationally can arrange a video consultation before travelling. Appointments for this service are requested by email at telemed@internistenzentrum.de.

38. Do I need a referral for FMT?

The requirements depend on the indication, insurance status and clinical circumstances. Patients should provide previous medical reports, laboratory results, microbiology and information about previous treatments so that the indication can be assessed efficiently.

39. How do I arrange an FMT consultation in Starnberg?

For international patients and patients with a long journey, contact telemed@internistenzentrum.de to request a video consultation. For recurrent C. difficile infection, the Center for Endoscopy also provides a dedicated enquiry process for urgent FMT requests.

40. Where is the Center for Endoscopy Starnberg?

The Center for Endoscopy is located at Oßwaldstraße 1, PoliCenter, 82319 Starnberg, Germany, southwest of Munich. International patients can begin with a video consultation before travelling.

Why Choose the Center for Endoscopy Starnberg?

The Center for Endoscopy Starnberg combines:

Gastroenterology
Advanced endoscopy
Microbiome-focused treatment
Experience with fecal microbiota transfer
The Starnberg bFMT concept
Scientific collaboration and publications
Individual medical assessment
Video consultation for international patients

The Starnberg bFMT approach has been published in the peer-reviewed medical literature, including the study of bidirectional FMT in recurrent C. difficile infection.

Bestfater C, Vehreschild MJGT, Stallmach A et al.
Clinical effectiveness of bidirectional fecal microbiota transfer in the treatment of recurrent Clostridioides difficile infections.
Digestive and Liver Disease. 2021;53:706–711.
PMID: 33744169

Read the study on PubMed

Medical Evidence at a Glance

Recurrent Clostridioides difficile infection

Evidence level: established clinical indication

FMT-based therapy is supported by randomized trials, systematic reviews and international guidelines for selected patients with recurrent CDI.

PMID: 38395525

IBS

Evidence level: investigational / not routine FMT

Randomized trials and meta-analyses show heterogeneous results. Current AGA guidance recommends conventional FMT for IBS only in clinical trials.

PMID: 37275867; PMID: 38395525

SIBO

Evidence level: preliminary

Clinical studies have reported improvements, but FMT is not currently established as routine eradication therapy.

PMID: 33549047; PMID: 42434160

IMO

Evidence level: insufficient for routine FMT

IMO is a methane-associated microbial overgrowth syndrome. Current evidence supports diagnostic breath testing and targeted treatment rather than routine FMT.

PMID: 42434160

Dysbiosis

Evidence level: diagnosis-dependent

„Dysbiosis“ alone is not sufficient to establish an indication for FMT.

Auto-Brewery Syndrome

Evidence level: case reports / emerging research

FMT has been reported but remains investigational.

PMID: 39647535; PMID: 41507585

Ulcerative colitis

Evidence level: promising but specialized

Randomized trials and meta-analyses indicate potential benefit, but conventional FMT is not yet routine standard treatment.

PMID: 40246750; PMID: 38395525

Request an FMT Consultation in Starnberg

Are you looking for fecal microbiota transplantation in Germany?

If you have recurrent Clostridioides difficile infection, IBS, SIBO, IMO, suspected microbiome-associated disease or another condition for which microbiome-based treatment has been discussed, we can assess whether FMT is medically appropriate for you.

Patients from Germany

Center for Endoscopy Starnberg
Oßwaldstraße 1
PoliCenter
82319 Starnberg
Germany

Telephone: +49 8151 971096

International patients

Start with a video consultation:

telemed@internistenzentrum.de

Please send your medical history and relevant reports before travelling whenever possible.

Important

FMT is not appropriate for every patient or every microbiome-related condition. The decision should be based on the underlying diagnosis, previous treatment, current evidence, potential benefits and risks.

References and Further Reading

van Nood E et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013. PMID: 23323867.
Kassam Z et al. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol. 2013. PMID: 23511459.
Kelly CR et al. Effect of Fecal Microbiota Transplantation on Recurrence in Multiply Recurrent Clostridioides difficile Infection. Ann Intern Med. 2016. PMID: 27547925.
Hvas CL et al. Fecal Microbiota Transplantation Is Superior to Fidaxomicin for Treatment of Recurrent Clostridium difficile Infection. Gastroenterology. 2019. PMID: 30610862.
Baunwall SMD et al. Faecal microbiota transplantation for recurrent Clostridioides difficile infection: an updated systematic review and meta-analysis. EClinicalMedicine. 2020. PMID: 33437951.
Bestfater C et al. Clinical effectiveness of bidirectional fecal microbiota transfer in the treatment of recurrent Clostridioides difficile infections. Dig Liver Dis. 2021. PMID: 33744169.
Ramai D et al. FMT with colonoscopy is superior to enema and nasogastric tube while comparable to capsule. Dig Dis Sci. 2021. PMID: 32166622.
Wang M et al. Fecal microbiota transplantation for irritable bowel syndrome: a systematic review and meta-analysis. Front Immunol. 2023. PMID: 37275867.
Yau YK et al. Randomised clinical trial: Faecal microbiota transplantation for irritable bowel syndrome with diarrhoea. Aliment Pharmacol Ther. 2023. PMID: 37667968.
Xu F et al. Clinical efficacy of fecal microbiota transplantation for patients with small intestinal bacterial overgrowth. BMC Gastroenterol. 2021. PMID: 33549047.
Peery AF et al. AGA Clinical Practice Guideline on Fecal Microbiota-Based Therapies for Select Gastrointestinal Diseases. Gastroenterology. 2024. PMID: 38395525.
Rapoport EA et al. Adverse events in fecal microbiota transplantation: a systematic review and meta-analysis. Ann Gastroenterol. 2022. PMID: 35479587.
Cheng F et al. Fecal microbiota transplantation for Crohn’s disease: a systematic review and meta-analysis. Tech Coloproctol. 2021. PMID: 33759066.
Gefen R et al. Fecal microbiota transplantation for patients with ulcerative colitis. Tech Coloproctol. 2025. PMID: 40246750.
Heaney C et al. Fecal microbiota transplantation in a long-standing auto-brewery syndrome with complex symptomatology. J Hepatol. 2025. PMID: 39647535.
Hsu CL et al. Gut microbial ethanol metabolism contributes to auto-brewery syndrome in an observational cohort. Nature Microbiology. 2026. PMID: 41507585.

Keywords:
fecal microbiota transplantation Germany, FMT Germany, stool transplant Germany, fecal microbiota transfer, FMT Starnberg, stool transplant Munich, fecal microbiota transplantation Munich, Starnberg Method, bidirectional FMT, bFMT

Secondary Keywords:
C. difficile FMT, recurrent C. difficile treatment, microbiome transplantation, gut microbiome treatment, FMT IBS, FMT SIBO, FMT IMO, Auto-Brewery Syndrome FMT, dysbiosis treatment, fecal transplant Germany, stool transplantation Germany