Microbiome Maxi Plus + gut barrier + absorption – complete gut test

Diversity describes how many different bacterial species occur in the gut and how evenly they are distributed. In research, a diverse gut flora is considered more stable against disturbances (PubMed 22972295); there is no generally valid cut-off.

The enterotype assigns the gut flora to one of three basic patterns, named after Bacteroides, Prevotella or Ruminococcus (PubMed 21508958). Later work shows gradual transitions rather than distinct types (PubMed 29255284). There is no "good" or "bad" enterotype. The report also shows the distribution of the major bacterial groups (phyla) and the Firmicutes-to-Bacteroidetes ratio.

The dysbiosis index is a figure calculated by the laboratory that summarises deviations of the measured bacteria from the reference range. Dysbiosis generally refers to a gut flora whose composition deviates from the usual; the term, however, is not uniformly defined.

The gut flora fluctuates from day to day and differs in every person (PubMed 40276224). An elevated index is therefore a snapshot, not a diagnosis; what it means is clarified in the results consultation.

Butyrate is a short-chain fatty acid that gut bacteria produce from dietary fibre; it is the main energy source for the cells of the colonic lining (PubMed 30580556). One of the best-known producers is Faecalibacterium prausnitzii, which was found in lower amounts in Crohn's disease (PubMed 18936492).

Akkermansia muciniphila lives in the mucus layer of the gut wall; lower amounts have more often been observed in overweight and metabolic disorders (PubMed 39940420). These are results from group comparisons; no meaning can be derived from them for a single value.

Calprotectin comes from white blood cells and rises in stool with inflammation of the intestinal lining (PubMed 31088326). In a meta-analysis it distinguished chronic inflammatory bowel diseases well from irritable bowel syndrome; an elevated value, however, does not prove such a disease (PubMed 37823411).

Alpha-1 antitrypsin in stool can indicate protein loss via the intestinal lining (PubMed 20571826). Elevated values of either marker should be checked by a doctor.

Zonulin can loosen the connections between the cells of the intestinal lining and is measured as a marker of "leaky gut" (PubMed 21248165). A widely used commercial assay, however, detects related proteins rather than zonulin itself (PubMed 29459849); the value is an indication, not proof.

Secretory IgA (sIgA) is the most important antibody of the mucous membranes (PubMed 21975936). An elevated value can indicate an activated mucosal defence, a low value a weaker one.

Histamine is formed in the gut, among other things by bacteria that convert the amino acid histidine, and is broken down mainly by the enzyme diamine oxidase (DAO) (PubMed 33921522). The report shows both the amount of histamine-producing bacteria and histamine in stool.

In one study, the gut flora of some people with irritable bowel syndrome produced particularly large amounts of histamine; in mice colonised with this flora, gut pain sensitivity increased (PubMed 35895832). Whether an elevated value contributes to your complaints cannot be read from this.

The digestive residues show how much fat, nitrogen, sugar and water remain in the stool; a lot of fat can indicate impaired fat digestion or absorption (PubMed 38429963). Low pancreatic elastase can indicate too few pancreatic digestive enzymes, which can show up as fatty stools, bloating, diarrhoea and weight loss (PubMed 37737818).

Bile acids in stool are studied in connection with chronic diarrhoea (PubMed 26913381). pH reflects how strongly bacteria ferment fibre in the large intestine (PubMed 11427691).

Yeasts such as Candida are part of the gut flora in small amounts in many healthy people (PubMed 36135388). Blastocystis and Dientamoeba fragilis are also often found in people without complaints: a 2026 review concludes that their detection does not indicate disease in people with an intact immune system (PubMed 42838172).

If diarrhoeal pathogens such as Giardia lamblia, Cryptosporidium or Entamoeba histolytica are detected, the result belongs with a doctor. More on parasites in the gut can be found on the biomarker page.

A microbiome test examines which bacteria and other microorganisms live in the gut and in what proportion. In molecular-genetic analysis, the genetic material of the bacteria is read directly from the stool sample. This also captures species that cannot be grown in the laboratory; a classic stool culture, in contrast, captures only selected key bacteria.

A stool test at the GP usually looks specifically for certain pathogens or for blood in the stool. A microbiome analysis replaces neither a medical examination nor bowel cancer screening.

A microbiome test is a snapshot: the gut flora changes with diet, medication and other influences. A study published in 2026 found that results from different test providers for the same sample differed about as much as the gut flora of different people (PubMed 41748906).

Individual markers such as calprotectin for inflammation (PubMed 31088326) or pancreatic elastase for the pancreas (PubMed 37737818) are more established. Your report states the laboratory's method and reference ranges; the test does not provide a diagnosis.

The intestinal lining lets nutrients through and holds back bacteria, toxins and undigested food components. "Leaky gut" describes a gut wall that is more permeable than usual. Increased permeability is well documented in conditions such as coeliac disease or chronic inflammatory bowel diseases; a distinct "leaky gut syndrome" as a diagnosis is not established (PubMed 31076401).

Antibiotics act not only against pathogens but also against many beneficial gut bacteria. In one study, the gut flora recovered only incompletely after repeated antibiotic courses, with large individual differences (PubMed 20847294).

For the test, therefore: if possible, 4 weeks after the last antibiotic dose. Never stop antibiotics on your own; if this interval is not possible, note the intake on the request form.

Research associates the gut flora, gut barrier and digestion with the following complaints and conditions, with varying strength of evidence:

• Irritable bowel syndrome with abdominal pain, bloating, diarrhoea or constipation: in a systematic review, less Faecalibacterium and Bifidobacterium and more Enterobacteriaceae; a more permeable gut wall in some patients (PubMed 30940523, PubMed 28404070).
• Chronic inflammatory bowel diseases such as Crohn's disease: less Faecalibacterium prausnitzii and elevated calprotectin, well documented (PubMed 18936492, PubMed 31088326).
• Fatty stools, diarrhoea and unintended weight loss with reduced pancreatic function: well documented (PubMed 37737818).
• Chronic diarrhoea due to bile acid loss: described in reviews (PubMed 26913381).
• Overweight and metabolic disorders: more often less Akkermansia muciniphila, observed in studies (PubMed 39940420).
• Histamine intolerance with bloating, headache, flushing or itching: described (PubMed 17490952).
• Skin problems such as acne or atopic dermatitis: discussed via the "gut-skin axis" (PubMed 40050613).

These are associations from studies, not causes in an individual. A stool test cannot explain complaints and does not provide a diagnosis. Persistent complaints should first be checked by a doctor.

With blood in the stool or black stool, unintended weight loss, fever, diarrhoea at night, severe or new abdominal pain, persistent vomiting or difficulty swallowing, the first step is a doctor's practice, not a self-test. The same applies if your bowel habits change for the first time from around age 50 or if bowel cancer, coeliac disease or chronic inflammatory bowel disease runs in the family.

If you suspect coeliac disease, do not stop eating gluten before the medical work-up, because the tests may otherwise come back falsely normal. A stool test does not replace bowel cancer screening.

This page does not give treatment recommendations. Whether a result means anything at all and which steps make sense depends on your overall situation: complaints, previous findings, medication and diet. That complaints improve by restoring the gut barrier has not yet been shown (PubMed 31076401).

What makes sense for you belongs in a conversation with the ORY expert team or with your doctor or naturopath, for example from the ORY expert network. The results consultation is included in the price.

If possible, no antibiotics for 4 weeks beforehand, no laxatives, colon cleansing or colonoscopy preparation for 3 days beforehand, and no alcohol or strongly laxative foods for 24 hours beforehand. Keep to your usual diet, no special diet right before the test. Only pause prescribed medication after talking to your doctor.

Collect the sample using the stool collection aid, without contact with toilet water or urine, and take material from different parts of the stool. Store it in the fridge for no more than 24 hours until shipping and send it from Monday to Thursday.

Analysis usually takes 7–21 days from the arrival of the sample at the laboratory. As soon as your report is ready, we let you know. A results consultation with the ORY expert team is included in the price.

Microbiome Maxi Plus + gut barrier + absorption costs €465 including VAT, shipping, return postage and results consultation.

Statutory health insurance in Germany generally does not cover microbiome and stool analyses you order yourself. With private insurance, reimbursement may be possible; how it works is described under "Reimbursement by private insurance".

Microbiome Maxi Plus + gut barrier + absorption (€465) combines the molecular-genetic gut flora with gut barrier and digestion markers. Microbiome Maxi Plus (€285) analyses only the gut flora; Gut barrier & absorption (€179.90) measures only gut barrier, inflammation and digestion. More compact are the basic gut profile (€285) and the gut profile microbiome & gut barrier (€315). The Metabolome (€380) additionally looks at bacterial metabolites and neurotransmitters in stool.

Which scope makes sense for you can be clarified in the free initial consultation.