What is Inflammatory Bowel Disease (IBD) and how it can be treated in SIngapore | Dr David Ong - A respected Singapore Gastroenterologist

Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease is a term for conditions characterised by chronic inflammation and subsequent damage of the gastrointestinal tract. This encompasses Crohn’s disease (CD), ulcerative colitis (UC), and inflammatory bowel disease unclassified (IBDU).

Constipation

What is Crohn’s Disease?

Crohn’s disease causes inflammation of the full thickness of the digestive tract wall and may affect any part of the digestive tract from the mouth to the anus. This differs from UC in that UC is the formation of ulcers (sores) and inflammation of only the inner lining of the large intestine (colon and rectum). Extraintestinal CD.

While the exact cause of CD remains unknown, aggravating factors such as diet and stress have been identified. Risk factors for developing CD include a malfunctioning immune system or a family history of CD (heredity).

Signs and symptoms and CD can vary from mild to severe. They also usually develop gradually but may sometimes come on suddenly without warning. Symptoms include:

– Diarrhoea

– Fever

– Fatigue

– Abdominal pain

– Nausea and vomiting

– Rectal bleeding and blood in stool

– Mouth sores

– Reduced appetite

– Weight loss

– Pain around the anus

Diagnosis and Management

If CD is suspected based on your symptoms, medical history, and physical examination, Dr Ong will need to use imaging tests such as X-rays or perform an endoscopy to look inside your digestive tract and confirm a diagnosis.

There are currently no known cures for Crohn’s disease. If diagnosed, strategies recommended aim to reduce inflammation and symptoms as well as prevent complications. Anti-inflammatory medications, immunosuppressive medications, anre antibiotics are commonly prescribed. Other treatment options include:

– Nutritional therapy and vitamin supplements

– Pain relievers

– Probiotics

– Laxatives

– Antidiarrheal medications

Ulcerative Colitis (UC)

What is Ulcerative Colitis (UC)?

Ulcerative colitis is the formation of ulcers (sores) and inflammation of the inner lining of the large intestine (colon and rectum). This differs from CD in that CD is the inflammation of the full thickness of the digestive tract wall and may affect any part of the digestive tract from the mouth to the anus.

Symptoms of UC vary depending on disease severity and its location. Signs and symptoms include:

– Diarrhoea, commonly with pus or blood

– Abdominal and/or rectal pain

– Rectal bleeding

– Urgency to defecate

– Constipation

– Fatigue

– Fever

– Weight loss

– Failure to grow in children

UC can be further classified according to its location. Types of UC include:

– Ulcerative proctitis – Inflammation is confined to rectum, close to the anus.

– Proctosigmoiditis – Inflammation involves both the rectum and the lower end of the large intestine (sigmoid colon).

– Left-sided colitis – Inflammation involves the rectum, sigmoid colon, and a large part of the large intestine that precedes the sigmoid colon (descending colon).

– Pancolitis – Inflammation that often affects the majority of the large intestine (the entire colon).

Diagnosis and Management

The definitive method to diagnose UC is through an endoscopy. Other types of tests such as X-rays can help to rule out complications or other forms of inflammatory bowel disease (IBD) such as Crohn’s disease (CD).

If diagnosed, UC treatment involves either drug therapy or surgery. Drug therapy includes anti-inflammatory drugs, immunosuppressant medication, and biologics. Other treatment options include:

– Probiotics

– Pain relievers

– Iron supplements

– Anti-diarrheal medications

– Antispasmodics

Surgery may also eliminate UC and involves removing a large section of your large intestine (colon) and rectum in a procedure known as proctocolectomy. In such a case, the patient may need to wear a bag to collect stool. To eliminate such a need, an additional procedure called ileoanal anastomosis (J-pouch) surgery is required. The surgeon would construct a pouch from the end of your small intestine to attach directly to the patient’s anus, allowing the patient to expel waste with relative ease.

Inflammatory Bowel Disease Unclassified (IBDU)

Inflammatory Bowel Disease Unclassified (IBDU) is the rarest of the IBD subgroups including CD and UC. IBDU is characterized by both clinical and endoscopic signs of long-term colon inflammation without features specific to CD or UC but rather subtle features of both. The incidence of IBDU is twice as common in children as it is in adults but is nevertheless rare. As such, its diagnosis and management are on a case-by-case basis.