Microbiome Restoration
Faecal Microbiota Transplantation (FMT) Treatment in Singapore
Microbiome restoration therapy is a medical treatment that rebuilds the balance of bacteria in your gut using screened, healthy donor stool. It is also known as faecal microbiota transplantation, or FMT. The best evidence for it is in recurrent Clostridioides difficile infection, where it works when repeated courses of antibiotics have not.
At PS Tan Digestive & Liver Centre, Dr Tan Poh Seng assesses whether this therapy is appropriate for you, arranges the donor material through a screened stool bank, and carries out the procedure at Mount Elizabeth Hospital.
What is FMT therapy?
Your large intestine holds trillions of bacteria that help digest food, train your immune system and keep harmful organisms in check. When that community is badly disrupted, usually after repeated antibiotics or a serious infection, it can struggle to recover on its own. Doctors call this dysbiosis.
Microbiome restoration therapy introduces a full, healthy bacterial community from a screened donor into your colon. The aim is to re-establish the diversity your gut has lost, rather than adding one or two strains the way a probiotic does.
You can read more about how gut bacteria influence health on our gut microbiome and health page.
When is faecal microbiota transplantation( FMT) considered?
This is not a wellness or general gut health treatment. It is considered when the gut ecosystem has been significantly disrupted and standard treatment has failed.
The clearest indication is recurrent C. difficile infection. This is a bacterial infection of the colon that causes repeated watery diarrhoea, cramping and fever, and it usually follows a course of antibiotics. Roughly one in five people get a second episode after their first, and the chance of another recurrence rises with each repeat.
The 2024 American Gastroenterological Association guideline recommends faecal microbiota based therapy for people who have had two or more recurrences, after they complete a course of standard antibiotics. It is also considered in severe or fulminant C. difficile infection that has not improved on antibiotics.
Published studies report that between 80 and 90 percent of patients with recurrent C. difficile have no further episodes after treatment, some after a single session and some after a repeat. Results vary from person to person and Dr Tan will discuss what is realistic in your case.
What about IBD, IBS and other conditions?
Research is active in inflammatory bowel disease, irritable bowel syndrome, liver disease, metabolic conditions and the gut to brain link, but the evidence is not yet strong enough for routine use. If you have ongoing digestive symptoms without a C. difficile diagnosis, the more useful first step is a proper workup. Dr Tan will look for treatable causes such as reflux, Helicobacter pylori, irritable bowel syndrome, etc and institute appropriate treatment.
How the FMT therapy is delivered
There are three routes in common clinical use. The choice depends on your diagnosis, your bowel anatomy and whether you need a scope for other reasons.
Colonoscopy. The donor preparation is placed directly into the right side of the colon during a colonoscopy. This is the most widely used route. You will need bowel preparation and sedation.
Enema. The preparation is given rectally without sedation or bowel prep. It reaches the lower colon only, so more than one session may be needed.
Oral capsules. Frozen or freeze dried capsules are swallowed in one session. No sedation, no scope, but you need to be able to swallow a number of capsules in a sitting.
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How donors are screened
Donor material is not accepted casually. Screening is the single most important safety step, and material used here comes from a regulated stool bank rather than from friends or family arranged informally.
Donors go through a detailed medical, travel and lifestyle history, a physical examination by a clinician, and blood and stool testing for viruses, bacteria, parasites and drug resistant organisms. Donors with conditions linked to gut bacteria, such as autoimmune disease, obesity or bowel disorders, are excluded.
Stool banks serving Singapore also draw on Asian donors, whose gut bacteria reflect regional diets and environments more closely than Western donor pools.
What to expect, step by step
- Consultation. Dr Tan reviews your history, previous test results and antibiotic courses, and confirms whether the therapy is appropriate. You may need stool testing, blood tests or a scope first.
- Preparation. If you are having a colonoscopy, you will follow the usual bowel preparation and fasting instructions. There are medications to take prior to the actual procedure.
- The procedure. The transplant itself takes a few minutes once the scope is in position. A colonoscopy session usually takes about 30 to 45 minutes in total, and you go home the same day.
- Recovery. Most people return to normal activity the next day. If you had sedation, you should not drive or work on the day of the procedure.
- Follow up. Dr Tan reviews you a few weeks later to confirm the infection has cleared. Some patients need a second session.
Risks and side effects
Most side effects are mild and settle within a few days. These include bloating, wind, abdominal cramping, loose stools and a low grade fever.
Less common risks relate to the delivery method rather than the transplant itself, such as bleeding or perforation during colonoscopy, or reactions to sedation. These are very rare in experienced hands.
The most serious theoretical risk is transmission of an infection from the donor. This is why screening protocols are strict. Reported cases worldwide are rare, and they have involved material that did not meet current screening standards.
Because the long term effects of changing your gut bacteria are still being studied, this therapy is reserved for situations where the benefit is clear.
Who may not be suitable for FMT?
This therapy is generally not offered to people who are severely immunocompromised, such as those who are neutropenic, on high dose immunosuppression or recovering from a bone marrow transplant. It is also deferred in people who are acutely unwell in other ways, or who cannot safely undergo the chosen delivery route.
Pregnancy, active cancer treatment and swallowing difficulties are all things to raise at your consultation, as they affect both suitability and the route chosen.
How is this different from probiotics?
A probiotic supplement contains a small number of selected bacterial strains, usually a handful. A microbiome transplant delivers a complete, established bacterial community along with the other components of a healthy gut environment.
Probiotics have a role in some situations and are far lower risk, but they have not been shown to resolve recurrent C. difficile infection. They are not a substitute for this therapy, and this therapy is not a substitute for a good diet.
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Frequently asked questions
Is microbiome restoration therapy the same as a faecal transplant?
Yes. Microbiome restoration therapy is the clinical term used for faecal microbiota transplantation, or FMT.
Does it hurt?
No. If it is done by colonoscopy you will be sedated. Enema and capsule routes are not painful, though some people find the capsules unpleasant to swallow in number.
How long before I feel better?
For C. difficile, diarrhoea often settles within days.
Can I choose my own donor?
Screened bank donors are preferred. Using a friend or relative without full laboratory screening carries real infection risk and is not recommended.
Will I need more than one session?
Some people do. A second session is usually offered if symptoms return or the infection is not fully cleared.
Can it help me lose weight or improve my skin?
There is no reliable evidence for this, and the therapy is not offered for these reasons.
Can this be discussed over a video consultation?
Yes. An initial discussion can be done by tele-consultation, though the procedure itself must be done in person.
Why Choose Us
Helmed by Dr Tan Poh Seng with years of gastroenterology experience and expertise
Endoscopic procedures such as Gastroscopy and Colonoscopy are personally performed by Dr Tan who has carried out thousands of these endoscopies
Personalised and Tailored Treatment Plan
Conveniently located at Mount Elizabeth Orchard Hospital
Speak to Dr Tan
If you have had repeated C. difficile infections, or your doctor has raised microbiome restoration therapy as an option, book a consultation to find out whether it is suitable for you.
Mount Elizabeth Hospital, 3 Mount Elizabeth, Singapore 228510
Call +65 6235 8233 or contact us to arrange an appointment.