Most of us have no qualms opening up about our health concerns. But when it comes to certain problems, especially those to do with our bowel, we clam up out of embarrassment.
But talking about symptoms like bloody stools, tummy discomfort and chronic diarrhoea with your doctor is important because they may indicate something more serious, like inflammatory bowel disease (IBD).
IBD use to more common in Western countries but it now appears to be on the rise in Singapore. About two decades ago, there were just a handful of known cases, but today, an estimated 2,000 people in Singapore have been reported to have the disease (although this figure could be a lot higher, since many people who experience symptoms are too shy to bring it up to their doctor or ask for help).
What is IBD?
According to Dr Ling Khoon Lin, a gastroenterologist at Mount Elizabeth Medical Centre, IBD encompasses ulcerative colitis and Crohn’s disease.
Ulcerative colitis causes inflammation of, and ulcers in, the large intestine. Crohn’s disease patients may have ulcers in any part of the gut from the mouth to the anus, with the most common parts affected being the terminal part of the small intestine and the large intestine.
No one knows for sure what causes IBD. It is thought that it occurs in people who have a genetic predisposition to the condition. “When these people are exposed to the appropriate environmental triggers – for example, certain bacteria – their gut immune system is activated but doesn’t turn off even when the bacteria are eliminated,” says Dr Ling. About 80 per cent of our immune system is thought to be located in our digestive tract.
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In the West, about 20 per cent of IBD patients have a relative who also has IBD. In Asia, that figure is just three to five per cent. But Dr Ling says that while IBD has a genetic component, it is thought that multiple genes contribute to one’s risk of developing the condition, so at the moment it is impossible to determine if one will inherit or develop IBD based on the fact that he or she has some genetic link to it.
The symptoms of IBD are varied. Dr Ling says that ulcerative colitis tends to cause chronic diarrhoea, with or without blood, while Crohn’s disease patients present with chronic diarrhoea, abdominal pain and blood in the stools. These patients may also lose weight, develop a fever, and experience anal fistulae (this is a small tunnel that develops between the end of the bowel and the skin near the anus, where the faeces leaves the body). An anal fistula is not only painful; it can also cause bleeding and discharge when passing stools.
A painful inconvenience
IBD is not fatal but it can affect the patient’s life in a number of ways. For one, patients have to put up with excruciating pain, especially when digested food moves along their inflamed digestive tract, irritating the intestinal lining.
Second, IBD sufferers are twice as likely to experience generalised anxiety disorders – including depression – than people who do not have IBD. These findings were the result of a study done by researchers at the University of Toronto, Canada, and published in the journal Inflammatory Bowel Diseases in 2015.
IBD is also inconvenient in that it tends to land the sufferer in hospital more often than people without IBD. The most common reasons for their hospital or ER visits include dehydration, fevers, blockages, abscesses and fistulas. More trips to the hospital may translate to a higher risk of contracting infections. Plus, the more treatments one receives for IBD, the higher her medical expenses.
How to treat and manage IBD
IBD symptoms can be relieved with medication or surgery, and long-term remission is possible, however, the disease has no cure.
Treatment for IBD in Singapore usually takes the ‘step-up’ approach, with more powerful medicines prescribed to patients if the less powerful ones do not work. How quickly one moves up this “IBD Treatment Pyramid” depends on the individual patient’s circumstances. Patients undergo surgery usually when there is no other alternative.
“New drugs are starting to come out to treat patients with severe ulcerative colitis and Crohn’s disease,” Dr Ling shares. “For example, a gut-selective biologic – a very powerful medication – has just been introduced in Singapore and that is used to treat patients when current treatments have failed or are not appropriate. More new drugs will be approved for use in IBD patients with severe disease within the next one to two years.”
Although IBD is not caused by an improper diet, it does certainly help to eat a healthy and balanced diet. Patients with active IBD are usually advised to avoid oily and fatty foods as well as dairy products, says Dr Ling.
Some patients with Crohn’s disease and strictures are advised to go on a low-fibre diet. A stricture refers to the abormal narrowing of a canal or duct in the body, and a low-fibre diet can help reduce the risk of obstruction at the point of stricture.
Finally, Dr Ling says that all Crohn’s patients are advised to stop smoking, as this on its own could reduce Crohn’s disease activity.