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.

IBD: Why it is more dangerous than IBS

Over time, IBD can lead to complications such as:

  • Bowel obstruction
  • Ulcers
  • 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), a member of the SingHealth group, which sees one of the largest number of IBD cases, the number of people visiting its Centre for Digestive and Liver Diseases (CDLD) for IBD has doubled over the last decade.

“Inflammatory bowel disease 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,” said Dr Shim Hang Hock, Consultant for the Department of Gastroenterology and Hepatology at SGH, and Director of the Inflammatory Bowel Disease Centre.

IBD: Causes, risks and symptoms 

Inflammatory bowel disease (IBD) 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 is 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:

  1. Crohn’s disease: Where inflammation can affect any part of the digestive tract, from the mouth to the large intestine
  2. Ulcerative colitis: Where inflammation affects only 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 stool
  • Weight loss

The disease can also come and go, fluctuating between periods where symptoms are severe and spells of remission. This is not unlike irritable bowel syndrome (IBS), which is also more likely to afflict IBD patients.

IBD: How it is diagnosed and treated

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.

Although IBD cannot be cured, 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.

Differences between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS)

​Inflammatory Bowel
Disease (IBD)
​Irritable Bowel
Syndrome (IBS)
Signs and symptoms
  • ​Abdominal pain and cramping
  • Diarrhoea
  • Blood in stools
  • Fever and fatigue
  • Reduced appetite
  • Weight loss
  • Inflammation in digestive tract
  • Ulcers in digestive tract
  • ​Abdominal pain and cramping
  • Diarrhoea
  • Constipation
  • Mucus in stool
  • Bloating and gas
  • No inflammation in digestive tract
  • No damage to digestive tract
How common is it​Affects around 1 in
10,000 Singaporeans
​Estimated to affect
20 per cent of the world's population

Medications commonly used include:

  • Anti-inflammatory drugs
  • Immunosuppressants
  • Antibiotics
  • Antibody-based treatments knowns as biologics
  • ​Lifestyle changes such as a balanced diet, regular exercise and reducing stress
  • Medications such as laxatives or anti-diarrhoeal drugs to relieve specific problems
  • Greater chance of getting colon cancer
  • Ulcers in digestive tract
  • Increased risk of surgery
  • Malnutrition
  • Anaemia
Impaired quality of life

Ref: M19