Question 1

How do I get a colonoscopy without seeing a specialist first?

Accepted Answer

In Australia, you can access a colonoscopy through a direct access referral from your GP. This means your GP sends a referral specifically for the procedure and Dr Tu performs the colonoscopy without needing a prior consultation. This is ideal for straightforward screening cases. Direct access colonoscopy significantly reduces wait times.

Question 2

Will I be fully asleep during my colonoscopy?

Accepted Answer

All colonoscopies in Dr Tu's practice are performed under sedation administered by a specialist anaesthetist. You will be comfortably asleep throughout and will not feel or remember the procedure.

Question 3

How long does a colonoscopy take?

Accepted Answer

The procedure typically takes 20 to 30 minutes. Allow approximately 2 to 3 hours in total for admission, preparation, the procedure, and recovery from sedation.

Question 4

What is the easiest bowel prep to tolerate?

Accepted Answer

Dr Tu offers a novel capsule-based bowel preparation — the first of its kind in Australia. It is completely tasteless, produces a superior clean, and avoids the unpleasant experience of drinking large volumes of liquid prep. It is also very safe.

Question 5

How soon can I eat after a colonoscopy?

Accepted Answer

You can usually eat a light meal within an hour or two of waking from sedation. Starting with something gentle such as toast, soup, or crackers is advised, returning to a normal diet by the next day.

Question 6

Why am I bloated every day even when I eat well?

Accepted Answer

Daily bloating despite a healthy diet can be caused by IBS, SIBO, food intolerances, motility issues, disruption of the gut microbiome, or intestinal parasites such as Blastocystis hominis and Dientamoeba fragilis — organisms that are frequently overlooked but can cause persistent bloating, fatigue, and diarrhoea. Persistent bloating almost always has a treatable underlying cause.

Question 7

Is blood in my stool an emergency?

Accepted Answer

A small amount of bright red blood is commonly from haemorrhoids, but should never be assumed without proper investigation. Dark or black stools, blood mixed through the stool, or bleeding with weight loss or change in bowel habit warrant urgent assessment. Any new rectal bleeding deserves a conversation with your doctor.

Question 8

What does it mean if my reflux is not responding to PPIs?

Accepted Answer

If reflux symptoms persist despite proton pump inhibitors, conditions like functional dyspepsia, eosinophilic oesophagitis, or bile reflux may be the cause — these mimic acid reflux but do not respond to acid suppression alone. Further investigation such as gastroscopy is warranted.

Question 9

Should I be worried about loose stools that will not go away?

Accepted Answer

Persistent loose stools lasting more than a few weeks should be investigated. Chronic diarrhoea can signal inflammatory bowel disease, coeliac disease, microscopic colitis, or parasitic infections such as Blastocystis and Dientamoeba fragilis. Blood tests, stool tests, and sometimes colonoscopy can identify or exclude serious causes.

Question 10

Can stress really cause gut symptoms?

Accepted Answer

The gut-brain connection is real — stress genuinely alters gut motility, sensitivity, and the microbiome. However, stress should not be used as a label before the right investigations have been done. A thorough approach addresses both stress and lifestyle factors while ensuring nothing organic has been missed.

Question 11

Can intestinal parasites cause IBS-like symptoms?

Accepted Answer

Parasites such as Blastocystis hominis and Dientamoeba fragilis are frequently overlooked and can cause persistent bloating, fatigue, and diarrhoea that closely mimics IBS. Dr Tu offers transcolonic antibiotic infusion for these infections — a targeted treatment delivering antibiotics directly to the site of infection — achieving a success rate of approximately 98%. Many patients treated for parasitic infections have been previously told they simply have IBS.

Question 12

What is faecal microbiota transplantation (FMT) and how does it work?

Accepted Answer

FMT involves transferring processed stool from carefully screened healthy donors into a patient's gastrointestinal tract to restore a healthy microbiome. Dr Tu performs FMT at the Centre for Digestive Diseases in Five Dock, which runs Australia's largest and longest-established FMT programme. Multi-donor preparations are GMP-certified and TGA-approved. Treatment can be delivered via colonoscopy, enema, or oral capsules depending on the clinical scenario.

Question 13

Who is a candidate for FMT in Australia?

Accepted Answer

The strongest evidence for FMT is in recurrent Clostridioides difficile infection, where cure rates exceed 85 percent. Beyond C. diff, FMT is also used in selected cases of ulcerative colitis using specialised antibiotic-FMT combination protocols. Each case is assessed individually.

Question 14

How many FMT treatments will I need?

Accepted Answer

For recurrent C. diff, a single colonoscopic FMT is often sufficient, though some patients benefit from a follow-up course. For ulcerative colitis, the protocol is more intensive — typically involving antibiotics and multiple FMT infusions over several weeks.

Question 15

Is FMT safe and what are the risks?

Accepted Answer

FMT has an excellent safety profile when performed within a regulated programme with rigorously screened donors. The programme at the Centre for Digestive Diseases uses multi-donor preparations with very stringent donor selection. There has been no recorded infection transmission since inception. The most common side effects are mild and transient — bloating, cramping, or a temporary change in bowel habit.

Question 16

Can FMT help conditions beyond C. diff infection?

Accepted Answer

Beyond C. diff, there is growing evidence for FMT in ulcerative colitis using antibiotic-FMT combination protocols. Research is also exploring FMT's role in IBS, metabolic syndrome, and other conditions linked to microbiome disruption.

Question 17

Can I get FMT if I have another condition like depression or chronic fatigue?

Accepted Answer

Having a co-existing condition such as depression, a neurological condition, autoimmune disease, or chronic fatigue syndrome does not automatically exclude you from FMT. Many of these conditions have emerging links to gut microbiome disruption. Each case is assessed individually taking into account the full medical history and current treatments.

Question 18

What is the difference between FMT capsules, enema, and colonoscopic FMT?

Accepted Answer

Colonoscopic FMT delivers donor material directly into the colon allowing for the largest volume and most targeted delivery. Enema-based FMT can be administered at home in some cases. Oral capsules are the least invasive and are often used for maintenance therapy. Many treatment plans use a combination — colonoscopic FMT as the initial treatment followed by capsules or enema for ongoing support.

Question 19

How do I know if my gut microbiome is damaged?

Accepted Answer

Symptoms such as persistent diarrhoea, bloating, or recurrent infections after antibiotic use can suggest microbiome disruption. A history of repeated or prolonged antibiotic courses is one of the strongest risk factors for significant microbiome damage. Assessment includes stool analysis and clinical evaluation.

Question 20

Can FMT reverse antibiotic damage to the gut?

Accepted Answer

In many cases yes. Antibiotics — especially broad-spectrum courses — can significantly reduce the diversity and balance of gut bacteria. FMT is one of the most effective ways to restore that diversity by reintroducing a complete healthy microbial ecosystem.

Question 21

How do I know if I have IBS or something more serious?

Accepted Answer

IBS should be a diagnosis of exclusion. Conditions like inflammatory bowel disease, coeliac disease, colorectal cancer, and parasitic infections such as Blastocystis and Dientamoeba fragilis must be ruled out first, especially if red flag symptoms are present such as bleeding, weight loss, anaemia, or onset after age 50.

Question 22

I have tried everything for my IBS — what else can I do?

Accepted Answer

For patients who have exhausted conventional IBS treatments, a combined approach targeting the gut-brain axis from multiple angles is recommended: microbiome modulation including FMT where appropriate, tailored dietary intervention to change the gut food environment, and gut-directed hypnotherapy to recalibrate central nervous system signalling. When you change the food, change the microbiome, and change the brain's response, you get the best outcomes.

Question 23

What is the difference between IBS and IBD?

Accepted Answer

IBS (irritable bowel syndrome) is a functional disorder — the gut looks structurally normal but does not function well. IBD (inflammatory bowel disease), which includes Crohn's disease and ulcerative colitis, involves actual inflammation and damage to the bowel visible on colonoscopy and biopsy. The treatments are very different.

Question 24

Why does my H. pylori keep coming back after treatment?

Accepted Answer

Recurrent H. pylori is often due to antibiotic resistance — standard triple therapy regimens fail more frequently due to increasing resistance patterns. Dr Tu uses vonoprazan-based combination therapy, a novel treatment offering far superior eradication rates compared to traditional PPI-based regimens, guided by sensitivity testing.

Question 25

What is SIBO and why is it so hard to treat?

Accepted Answer

SIBO — small intestinal bacterial overgrowth — occurs when bacteria that normally reside in the colon proliferate in the small intestine. Hydrogen-dominant SIBO tends to cause diarrhoea while methane-dominant overgrowth causes bloating and constipation. It is difficult to manage because antibiotics can temporarily clear the overgrowth but without addressing the underlying cause such as motility issues or structural factors it tends to recur.

Question 26

Can ulcerative colitis go into long-term remission?

Accepted Answer

Yes. With the right treatment strategy, many patients with ulcerative colitis achieve sustained remission. Treatment options include conventional medications, biologics, and antibiotic-FMT combination protocols.

Question 27

Why do I keep getting C. diff infections after antibiotics?

Accepted Answer

Recurrent C. diff is a vicious cycle — antibiotics used to treat the infection further damage the gut microbiome, which is what normally keeps C. diff in check. FMT breaks this cycle by restoring a healthy microbiome in a way that antibiotics alone cannot. Two or more recurrences is a strong indication for FMT.

Question 28

Is there a test that can tell me exactly what is wrong with my gut?

Accepted Answer

There is no single test that provides all the answers, but the right combination of investigations can be very revealing. Depending on symptoms this may include blood tests, stool studies, breath testing, colonoscopy, gastroscopy, or advanced techniques like confocal laser endomicroscopy (Cellvizio), which allows examination of the gut lining at a cellular level in real time during the procedure.

Question 29

Can coeliac disease develop later in life?

Accepted Answer

Yes. While coeliac disease has a genetic basis it can present at any age. It is worth considering with persistent diarrhoea, iron deficiency, unexplained weight loss, or a family history of coeliac disease. A blood test for coeliac antibodies followed by gastroscopy with duodenal biopsies is the standard diagnostic pathway.

Question 30

What causes microscopic colitis and how is it diagnosed?

Accepted Answer

Microscopic colitis causes chronic watery diarrhoea, often in patients over 50. The colon looks completely normal on colonoscopy — diagnosis is only made by taking biopsies, which is why it is called microscopic. Certain medications, autoimmune conditions, and smoking are known risk factors. It responds very well to treatment once diagnosed.

Shore Gastroenterology: gastroenterologist on Sydney's Lower North Shore and Northern Beaches

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