Singapore is seeing a rising incidence of inflammatory bowel disease. Dr Chok Aik Yong, Consultant Surgeon and Medical Director at Aelius Surgical Centre, Mount Elizabeth Orchard, Singapore shares IBD risk factors, symptoms, and treatments with For Life.

For Life (FL): What is IBD and how prevalent is it in Singapore?

Dr Chok Aik Yong (Dr C): IBD is a group of disorders characterized by chronic inflammation of the digestive tract that leads to damage of the digestive tract and consequently, impairment of its functions. When the digestive tract loses its function, it cannot digest food and absorb nutrients normally, leading to malabsorption. Having IBD for many years also puts a patient over 13% at risk of developing colorectal cancer. In Singapore, an estimated 1,500 individuals are suffering from IBD.

FL: Are there different types of IBD? What are they?

Dr C: Crohn’s disease and ulcerative colitis are the two main types of IBD. Crohn’s disease can affect any part of the digestive tract from the mouth to the anus, but the most commonly affected areas are the last part of the small intestine, colon, and area around the anus. Crohn’s disease disrupts all layers of the bowel, leading to complications such as perforation and narrowing. Meanwhile, ulcerative colitis affects the rectum and colon, and in severe cases, the entire colon may be affected by chronic inflammation, causing ulcers to develop along the inner lining of the colon.

Dr Chok Aik Yong, Consultant Surgeon and Medical Director at Aelius Surgical Centre, Mount Elizabeth Orchard

Dr Chok Aik Yong, Consultant Surgeon and Medical Director at Aelius Surgical Centre, Mount Elizabeth Orchard

FL: Can you share some of the risk factors associated with IBD?

Dr C: IBD has many risk factors. For example, IBD is more commonly diagnosed among males, particularly among Asians, and smokers. As genetics are also proven to play a role, having a family member that has IBD is also a risk factor for another family member developing the disease.

Among the environmental factors associated with IBD, diet plays an important role in influencing the normal microorganisms in the gut. The balance between good and bad bacteria in the colon impacts the course of the disease. Data shows that a high protein intake was also associated with a 3.3-fold increased risk of developing IBD.

IBD most commonly occurs at two age peaks. The first is during early adulthood, affecting individuals in their 20s and 30s, while in the late-onset group, individuals in their 50s and 60s develop the disease. Other risk factors include smoking and lack of physical activity.

 FL: What are the symptoms of IBD?

Dr C: IBD symptoms depend on the part of the digestive tract affected and the severity of the inflammation. Patients with mild inflammation may have little to no abdominal pain, and occasional diarrhoea or small amounts of blood in their stools. When severe inflammation occurs, patients experience the worsening and persistent abdominal pain, fever, and more frequent bloody stools.

Common symptoms of IBD are fever, anaemia, and growth retardation in young adults, while some symptoms are unique to either Crohn’s disease or ulcerative colitis.

The main symptoms associated with Crohn’s disease are abdominal pain, diarrhoea, general tiredness, and weight loss. On the other hand, primary symptoms associated with ulcerative colitis are bloody diarrhoea, abdominal pain, and constant tiredness.

 FL: How can IBD be treated?

Dr C: The diagnosis of IBD is achieved by combining clinical, laboratory, endoscopic, microscopic examination of tissues (histological), and radiological findings. IBD is a complex disorder to manage often requiring a multidisciplinary approach involving the colorectal surgeon, gastroenterologists, specialised nurses, pharmacists, and dieticians working together.

Some patients require surgery or multiple surgeries that increase their nutritional requirements and require more careful wound care. Doctors often opt for the laparoscopic approach as it comes with less pain and faster recovery. During an acute flare-up of IBD, bowel rest is required, and in some cases, total parenteral nutrition (TPN) may be required, where the nutrition is given intravenously to supplement and meet the body’s caloric requirements.

Newer medications, especially biologic therapy, can be more effective but are also more expensive. Unfortunately, in some cases, surgery is the only solution for IBD patients who develop complications that arise from untreated and uncontrolled IBD or past surgeries.

 FL: How can one be more proactive when it comes to IBD?

Dr C: IBD that is left to progress would have a negative impact on disease and treatment outcomes. As IBD occurs in adults of any age, the medical, financial, and social implications are often devastating and long-lasting. It is important that young and old adults monitor their bowel movements. Passing motion fewer than three times a week or more than three times a day, may not be normal. If these kinds of bowel movements persist for longer than a few weeks, or even a few months, further investigation is needed. Bleeding through the anus or bloody stools is never normal as well.

Nutrition is important in the management of IBD as the chronic unhealthy state of the colon causes patients to become malnourished. For normal individuals, consuming diets containing moderate to high amounts of fibre, a good balance of carbohydrate and protein, while reducing excessive salt and sugar in daily diet are essential to maintaining a healthy digestive system.

Featured photo by Shutterstock. Dr Chok Aik Yong photo courtesy of Dr Chok Aik Yong.