What Is Inflammatory Bowel Disease (IBD)?
Inflammatory Bowel Disease (IBD) is characterised by chronic inflammation of the gastrointestinal (GI) tract, and it mainly comprises Crohn's disease and ulcerative colitis. These conditions tend to have a serious impact on one’s quality of life; hence making personalised, long-term medical management all the more important.
In Singapore, the prevalence of IBD has been on the rise with an estimated 2,000 patients as of 2022.
What Are the Types of Inflammatory Bowel Disease?
The two most common types of IBD are Crohn's disease and ulcerative colitis:
Crohn's Disease
Crohn's disease can affect any part of the GI tract, from the mouth to the anus, but most commonly affects the end of the small bowel (the ileum) and the beginning of the colon. It can involve different areas of the GI tract in different people. Unlike ulcerative colitis, which affects only the innermost lining of the colon, Crohn's disease can affect all layers of the bowel walls.
Symptoms of Crohn's disease include diarrhoea, abdominal pain, weight loss, and fatigue. The inflammation caused by Crohn's disease can be patchy, with areas of disease separated by healthy tissue.
Ulcerative Colitis
Ulcerative colitis is limited to the colon (large intestine) and the rectum. It only affects the colon's innermost lining, causing ulcers and inflammation. Ulcerative colitis typically starts in the rectum and may extend continuously to involve the entire colon.
Symptoms include bloody stools, abdominal cramping, and urgency to defecate. Unlike Crohn's disease, the inflammation caused by ulcerative colitis is continuous, not patchy, and only involves the colon's innermost lining.
What Are the Risk Factors for IBD?
Understanding the risk factors is crucial for early detection and management. Here is an overview of the key risk factors associated with IBD:
Age
IBD can occur at any age, but it is most often diagnosed in individuals below 30 years. However, some people develop the disease much later.
Genetics and Family History
Individuals with a close family member with IBD are at a higher risk of developing the condition.
Environmental Factors
Factors like diet, lifestyle, and pollution can influence it. Diets rich in fat and sugar, lack of sunlight causing vitamin D deficiency, and sedentary habits are considered environmental risk factors in IBD.
Immune System Dysfunction
Immune response abnormalities to gut flora are thought to be a factor in IBD. The immune system may wrongly attack GI tract cells, causing chronic inflammation.
Lifestyle Factors
Smoking, lack of physical activity, poor diet, and disrupted sleep patterns can increase the risk of IBD. Additionally, stress and depression have also been considered as potential risk factors.
How Is IBD Diagnosed?
Diagnosing IBD can be complex as some of its symptoms are similar to other digestive disorders. However, there are several methods that doctors use to diagnose IBD, including:
Physical Examination
The IBD doctor will check for bloating in the abdomen, listen to sounds within the abdomen using a stethoscope, and palpate certain areas to identify pain or tenderness.
Blood Tests
Blood tests are used to look for signs of inflammation or anaemia, which is common in IBD. These tests can reveal high levels of white blood cells or low levels of red blood cells, indicating an inflammatory process or bleeding.
Imaging Scans
Imaging scans such as CT scans, MRI scans, and X-rays allow doctors to see detailed images of the GI tract. This helps identify areas of inflammation, blockages, or other abnormalities and determine the extent and location of the disease.
Stool Tests
Stool tests help detect the presence of blood, pathogens, or markers of inflammation in the digestive tract. They can differentiate between IBD and infections caused by bacteria, viruses, or parasites that may cause similar symptoms.
Endoscopy
Procedures like colonoscopy and sigmoidoscopy involve inserting a flexible tube with a camera into the rectum to visually examine the colon and end of the small intestine. Tissue samples (biopsies) can be taken during these procedures to look for signs of inflammation and ulceration characteristic of IBD.
Capsule Endoscopy
For this test, the patient swallows a small capsule that contains a camera, which takes thousands of pictures of the small intestine as it passes through. This can help identify inflammation or bleeding in parts of the GI tract that are hard to reach with traditional endoscopy.
Treatments for IBD
Inflammatory bowel disease treatment involves managing symptoms, reducing inflammation, and preventing flare-ups. The specific treatment plan will depend on the type of IBD, the severity of symptoms, and individual factors. Common treatment options include:
Medications
IBD medications are crucial for managing IBD by reducing inflammation and preventing flare-ups. They include aminosalicylates for mild to moderate symptoms, corticosteroids for acute flare-ups, and immunomodulators or biologics for severe cases, aiding in symptom control and remission.
Lifestyle and Dietary Changes
Lifestyle changes, like adjusting diet, can greatly help manage IBD symptoms. Patients should avoid trigger foods, reduce stress, and exercise regularly. These adjustments enhance well-being and lessen flare-ups.
Surgery
Surgery may be needed for IBD patients if medications and lifestyle changes fail to control the disease adequately or if there are complications present. Procedures include removing damaged sections of the GI tract or repairing obstructions/fistulas. While not curative, surgery can relieve symptoms and enhance one’s quality of life.
Complications of IBD
IBD can lead to various complications if not properly treated:
Bowel Obstruction
IBD can cause parts of the bowel to narrow due to inflammation and scar tissue, leading to blockages that prevent the passage of digested food.
Fistulas
Particularly common in Crohn's disease, fistulas are abnormal connections that can form between different parts of the intestine or between the intestine and other organs.
Risk of Colon Cancer
Individuals with IBD, especially those with a long history of ulcerative colitis, have an increased risk of developing colon cancer.
Perforation and Toxic Megacolon
In severe cases of ulcerative colitis, the colon may become so inflamed that it tears (perforation) or rapidly expands and fails to expel gas or stool (toxic megacolon), both of which are medical emergencies.
Extraintestinal Complications
IBD can also affect other parts of the body, leading to conditions such as ankylosing spondylitis (a form of spinal arthritis), skin conditions, mouth sores, and eye inflammation.
Living with IBD
Living with IBD can present significant challenges that require lifelong management to maintain a healthy and active lifestyle. Individuals with IBD must engage in regular health monitoring with their gastro specialists and undergoing necessary screenings. Additionally, it is crucial to stay vigilant for any new or worsening symptoms. Effective coping strategies are also vital. These might involve stress reduction techniques and joining support groups to connect with others facing similar challenges.
Frequently Asked Questions (FAQs)
Meet Our IBD Specialist
Dr Kieron Lim
MBBS, University of LondonMember, Royal College of Physicians (UK)Fellow, Academy of Medicine (Gastroenterology) SingaporeFellow, Royal College of Physicians (Edinburgh)
Dr Kieron Lim is a specialist in gastroenterology and hepatology with two decades of experience treating a full range of gastrointestinal and liver conditions. Dr Lim was formerly the Head of the Division of Gastroenterology and Hepatology at the National University Hospital, where he continues to be involved in postgraduate education and the training of future specialists. Dr Lim is committed to providing personalised, supportive and effective care to his patients with IBD, enabling them to live a better quality of life.
Location
Mount Elizabeth Medical Centre
3 Mount Elizabeth #10-02Singapore 228510
Contact Us
Whatsapp: (65) 9726 0495 | Telephone: (65) 6836 0080
Fax: (65) 6836 0090 | Emergency: (65) 6533 0088
Email: enquiries@kieronlimgastro.sg