- Misunderstood and under reported, incurable disease often mistaken as irritable bowel syndrome (IBS) due to similar symptoms


Waise Koh was only 18 when he was diagnosed with ulcerative colitis, a form of inflammatory bowel disease (IBD), while preparing for his A-Levels in 2013. At first, he thought his diarrhea was due to food poisoning, but when he passed bloody stools more than 20 times daily for a month, he felt something was wrong. Trawling the Internet, he found information which suggested ulcerative colitis (UC) – an uncommon condition in Singapore not easily diagnosed by GPs. After a second visit to the A&E, a gastroenterologist confirmed the diagnosis. By that time, Waise’s weight had dropped by more than 10kg.

IBD – including Crohn’s disease (CD) - was once considered to be a western disease. But in recent years, this condition has become more prevalent in Asia, including Singapore. Just last year at SGH’s Centre for Digestive and Liver Disease, the IBD clinic saw close to 600 patients, which is a two-fold increase since 2007.  This number is likely to increase exponentially as many patients are diagnosed before 30 years of age and carry the disease till their old age.

Although IBD is incurable, it can be treated and kept under control. Without treatment, Crohn’s disease and ulcerative colitis may carry an increased risk of developing colon cancer. Up to 50% of Crohn’s disease patients and 30% of ulcerative colitis patients may require surgery in their life time to remove part of their intestine.

Symptoms of IBD are often subtle and are commonly being mistaken as irritable bowel syndrome (IBS), a completely different and benign condition which does not result in any inflammation of the intestine. This includes symptoms such as poor appetite, bloating, abdominal pain and diarrhoea which may or may not be bloody. Due to the lack of awareness about IBD and symptoms mistaken as IBS, the condition often goes undetected and as a result, diagnosis is delayed.

It is not known what causes IBD although it is believed to be due to a disturbance of the immune balance, possibly triggered by environmental factors, or bacteria in the gut, in a person who is genetically at risk. Ulcerative colitis only affects the large intestine, while Crohn’s disease can affect any part of the intestine from mouth to the large intestine. Treatment for both, however, is similar.

Anti-inflammatory drugs are usually given as an initial treatment and sufficient for most patients. Depending on the severity and extent of the problem, other medications to suppress the immune system may be given. Biologics are the latest addition to the treatment list especially for patients who do not respond to conventional medications.

Patients with IBD can actually live a normal life just like anyone.  Medical advancement in the recent decade has improved control of the disease. The risks of surgery and hospitalization have been significantly reduced.

Waise had an aggressive form of the disease which did not respond to conventional medications. He was put on biologics treatment and has not experienced any symptoms since. He no longer has to constantly worry about access to toilets when he is out.

Although Waise was unable to enter medical school as the illness affected his A’Levels results, he has not given up his dream on becoming a doctor. Following treatment, he has since taken up a computational biology course in NUS, one which could reopen his door to medical school in future.