Inflammatory bowel disease on the rise
IF LEFT untreated, inflammatory bowel disease can lead to an increased risk of colon cancer.
Inflammatory Bowel Disease ( IBD) is becoming more widespread in Singapore. And while the disease shares some symptoms like diarrhoea, stomach cramps and abdominal pain with the more common irritable bowel syndrome ( IBS), IBD is a far more worrying condition.
Over time, IBD can lead to complications such as bowel obstruction, ulcers and perforations in the intestines. Also unlike IBS, which is a benign condition, IBD increases the risk of surgery and cancer.
At Singapore General Hospital (SGH), which sees one of the largest number of IBD cases, the number of people visiting its Centre for Digestive and Liver Diseases for IBD has doubled over the last decade.
According to Dr Shim Hang Hock, Consultant, Department of Gastroenterology and Hepatology, SGH, the Centre saw nearly 600 cases of the disease in 2017, versus 272 in 2007.
“Inflammatory bowel disease is not a very common disease, but we are seeing an emerging trend in Asia, including Singapore,” said Dr Shim, who is also Director, Inflammatory Bowel Disease Centre.
“This is a very aggressive disease. It can increase the risk of cancer and surgery, and there is significant economic and psychological burden ( on patients). But if you can get the disease under control with medication, most people actually do well and live a normal life.”
The disease can strike at any age, although most sufferers are diagnosed between the ages of 20 and 40 years. It also affects men and women equally.
It’s not known what causes IBD but doctors believe that the interaction of various factors – including genes, micro bacteria in the gut, diet and environmental factors – might trigger an inappropriate immune response that causes inflammation and sores in the digestive tract.
The two main types of IBD are Crohn’s disease (where inflammation can affect any part of the digestive tract, from the mouth to the large intestine) and ulcerative colitis (which only affects the large intestine).
The symptoms for IBD are varied and may range from mild to severe, depending on where it occurs and how bad the inflammation is. The most common signs of the disease include abdominal pain, persistent diarrhoea, blood in the stool and weight loss.
The disease can also come and go, fluctuating between periods where symptoms are severe and spells of remission. This is not unlike IBS, which is also more likely to afflict IBD patients.
Because of the similarities between IBD and IBS, blood tests, imaging and endoscopic procedures are necessary to rule out the latter or other possible causes to properly diagnose the disease. In addition to going through the patient’s history, blood tests, and imaging and endoscopic procedures are done to confirm the disease.
IBD cannot be cured, but it can be effectively treated and controlled with medication for most patients.
Drugs like aminosalicylic acids are used to reduce inflammation, while immunosuppressants such as steroids help suppress the activity of the immune system.
For those who do not respond to such medications, other options may include biologics, a new antibody-based treatment given by injection that stops certain proteins in the body from causing inflammation.
In serious cases, patients may have to undergo surgery to remove damaged portions of their digestive tract. However, medical advancements in the last 20 years have helped slow the progression of the disease, making surgery less common in recent years.
• This story was first published in Singapore Health, Nov - Dec 2018 issue.