Inflammatory Bowel Disease (IBD)

IBD symptoms like diarrhoea, abdominal pain, and rectal bleeding can mimic colorectal cancer.

A colonoscopy is essential to confirm the diagnosis and guide long-term treatment.

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Inflammatory Bowel Disease (IBD) is a chronic inflammatory condition that affects the gastrointestinal (GI) tract, most commonly the small intestine and colon through the esophagus and stomach can also be involved in Crohn's disease. Unlike Irritable Bowel Syndrome (link to IBS page) (IBS), which does not cause visible damage to the digestive tract, IBD results in ongoing inflammation, ulceration, and structural changes to the bowel lining.

There are two main types of IBD:

Crohn’s disease – which can affect any part of the digestive tract, from the mouth to the anus. Inflammation may occur in patchy segments, and penetrate deep into the bowel wall.
Ulcerative colitis – which affects only the colon and rectum, with continuous inflammation limited to the innermost lining of the bowel.

IBD is a progressive condition. This means that without treatment, it can lead to complications such as intestinal strictures, fistulas, intra-abdominal abscesses, subcutaneous abscesses, and an increased risk of colorectal cancer. However, with timely medical care, and appropriate management, symptoms can be controlled, flare-ups minimised, and quality of life significantly improved.

What causes Inflammatory Bowel Disease (IBD)?

The exact cause of IBD is not fully understood. But research suggests it arises from a complex interaction of genetic, immune, environmental, and microbial factors. These elements work together to trigger, and sustain inflammation in the gut.

Genetic predisposition

Individuals with a family history of IBD are at higher risk of developing the condition. Over 200 genetic variants have been associated with IBD, many of which affect the immune system’s ability to recognise, and regulate responses to intestinal bacteria. When these genes malfunction, the immune system may react inappropriately to normal gut flora, triggering chronic inflammation.

Abnormal immune response

IBD is considered an autoimmune condition. In a healthy individual, the immune system protects against harmful pathogens while tolerating harmless microbes in the gut. In IBD, this balance is lost. The immune system mistakenly attacks the body’s own intestinal tissue, leading to continuous inflammation. This immune overactivity causes tissue damage, ulceration, and the symptoms of IBD, such as diarrhoea, and abdominal pain.

Gut microbiome imbalance (dysbiosis)

The gut is home to trillions of bacteria that help regulate digestion, and immunity. In IBD, there is often a loss of microbial diversity, and an increase in pro-inflammatory bacteria. This imbalance can disrupt the gut barrier, and trigger immune activation, perpetuating the cycle of inflammation.

Environmental triggers

Certain environmental factors can initiate or worsen IBD in genetically predisposed individuals. These include:

Antibiotic use — frequent or early-life antibiotic exposure can disrupt the natural gut flora, potentially contributing to dysbiosis.
Diet — high-fat, low-fibre diets, and processed foods may alter gut bacteria, and promote inflammation.
Infections — gastrointestinal infections can damage the gut lining, and disturb immune regulation, acting as a potential trigger for IBD onset.

Smoking

Smoking affects Crohn’s disease, and ulcerative colitis differently. In Crohn’s disease, smoking is strongly linked to disease onset, more severe symptoms, and poorer treatment outcomes. It may impair blood flow to the gut, worsen immune dysregulation, and delay healing.

Conversely, in ulcerative colitis, smoking appears to have a mildly protective effect, though the risks of smoking far outweigh any benefit.

Stress and lifestyle

While stress does not directly cause IBD, it can influence the course of the disease. Chronic stress can alter gut motility, increase intestinal permeability (commonly referred to as "leaky gut"), and impact immune function. Subsequently, flare-ups exacerbate.

What are the symptoms of Inflammatory Bowel Disease (IBD)?

IBD symptoms can vary depending on the type, and severity of inflammation, but often include:

Abdominal pain, and cramping.
Chronic diarrhoea (sometimes with blood or mucus).
Delayed growth or puberty in children, and teenagers.
Fatigue or low energy.
Fever or malaise during flare-ups.
Unintended weight loss.
Urgency to pass stool or incomplete evacuation.

Additionally, in severe cases, complications such as bowel obstruction, abscesses or fistulas may occur.

If you are experiencing the symptoms,

consult a medical professional immediately.

Schedule an appointment with Dr Aaron Poh.

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Who is at risk of Inflammatory Bowel Disease (IBD) in Singapore?

While IBD was traditionally more common in Western countries, it is increasingly diagnosed in Singapore due to lifestyle changes, urbanisation, and better awareness. Certain individuals are at higher risk of developing IBD due to several factors, such as:

Age — IBD commonly begins between the ages of 15, and 35 years old. However, it can occur at any age. Due to their young age, the symptoms may affect school or work performance, and quality of life.
Ethnic background — although IBD affects all ethnicities, there is a rising incidence in Asian populations, including in Singapore, due to dietary, and environmental shifts.
Family history — having a first-degree relative with Crohn’s disease or ulcerative colitis increases your risk significantly, particularly if multiple family members are affected.
History of autoimmune conditions — individuals with autoimmune disorders such as psoriasis, rheumatoid arthritis or coeliac disease may have a higher chance of developing IBD.
Environmental exposure — factors such as a diet low in fibre, high use of antibiotics, and previous gastrointestinal infections may play a role in triggering IBD.
Smoking habits — smoking is associated with a higher risk of developing Crohn’s disease, and can worsen its course. Interestingly, it may slightly reduce the risk of ulcerative colitis, but this does not outweigh its health risks.

How is Inflammatory Bowel Disease (IBD) diagnosed in Singapore?

As IBD symptoms can mimic other gastrointestinal conditions, diagnosis involves a combination of clinical evaluation, imaging, endoscopy, and laboratory tests. Confirming the diagnosis is essential to guide appropriate treatment, and avoid unnecessary complications.

This includes:

Medical history and symptom review — Dr. Aaron Poh (link to doctor’s page) will begin with a detailed history, including the duration, and pattern of your bowel symptoms, any weight loss, bleeding, or family history of IBD or colorectal cancer.
Physical examination — this includes an abdominal and rectal examination to check for tenderness, masses or signs of active inflammation.
Blood and stool tests — blood tests may show signs of inflammation (elevated CRP, ESR), anaemia or low albumin. Meanwhile, stool tests (faecal calprotectin) help distinguish IBD from other non-inflammatory causes of diarrhoea.
Imaging tests — cross-sectional imaging, including a computed tomography (CT) scan, and magnetic resonance imaging (MRI), helps detect complications such as strictures, abscesses or fistulas, particularly in Crohn’s disease, where small bowel involvement is common.
Colonoscopy and biopsy — a colonoscopy is the most definitive tool to visualise the bowel lining, assess disease extent, and take tissue samples. Biopsies confirm inflammation, ulceration or specific patterns of IBD.

What are the treatment options for Inflammatory Bowel Disease (IBD) in Singapore?

IBD treatment focuses on controlling inflammation, reducing flare-ups, and preventing complications. Management is personalised depending on the disease type, severity, and response to previous treatment.
Some of the treatment options include:

Medical Management

Aminosalicylates (5-ASA) — commonly used in ulcerative colitis, these drugs reduce inflammation in the colon, and are often taken long-term to prevent relapses.
Antibiotics — sometimes prescribed for infections, abscesses or to manage bacterial overgrowth in Crohn’s disease.
Biologic therapies — targeted treatments such as anti-TNF agents (infliximab, adalimumab), anti-integrins or IL-12/23 inhibitors are used in patients who do not respond to conventional therapies.
Corticosteroids — these are effective for inducing remission during acute flare-ups but are not recommended for long-term use due to side effects.
Immunomodulators — drugs like azathioprine or methotrexate suppress the immune system, and help maintain remission in moderate-to-severe cases.
Nutritional support — tailored diets or enteral nutrition may be used, especially in children or during active flare-ups, to support healing and weight maintenance.

Surgical Intervention

Surgery is considered when:

Medical treatment fails to control symptoms.
There are complications such as strictures, fistulas or perforation.
Cancer or high-grade dysplasia is detected.

For ulcerative colitis – removal of the colon (colectomy) may offer a cure, often followed by creation of a stoma or ileal pouch.

For Crohn’s disease – surgery may involve resection of the affected bowel, abscess drainage or fistula repair, but it is not curative as the disease may recur in other segments.

Clinical Trials

For patients who do not respond well to standard therapies or are interested in novel treatments, clinical trials may offer access to the latest advancements in IBD care. These may include:

New biologics or small molecules.
Novel drug delivery systems.
Personalised treatment based on genetic markers.

Dr. Aaron Poh can discuss suitable clinical trials available in Singapore, and whether participation may be appropriate for your condition.

Schedule Your Appointment with Dr Aaron Poh.

Summary

IBD is a lifelong condition, but with the right medical care, most individuals can lead full, and active lives. While IBD can significantly impact daily routines, early diagnosis, and targeted treatment can help control symptoms, prevent complications, and improve long-term outcomes.

Ongoing follow-up is important to monitor disease activity, adjust therapy as needed, and screen for related conditions such as colorectal cancer.

If you are experiencing persistent digestive symptoms or have a family history of IBD, do not delay seeking help. Dr. Aaron Poh is here to support you with expert, compassionate care every step of the way. Get in touch today (link to contact us page) to schedule an appointment, and take control of your gut health.

Frequently Asked Questions (FAQs)

Is Inflammatory Bowel Disease (IBD) the same as Irritable Bowel Syndrome (IBS)?

IBD, and IBS are two different conditions. IBD involves chronic inflammation, and damage to the digestive tract, while IBS is a functional gut disorder that does not cause visible damage or inflammation.

Additionally, IBD may lead to serious complications if untreated, whereas IBS, though uncomfortable, is not associated with long-term bowel damage.

Can IBD be cured?

There is currently no cure for IBD, but it can be effectively managed. Many people achieve long-term remission with the right combination of medications, lifestyle changes, and in some cases, surgery. As such, early treatment, and close follow-up help reduce flare-ups, and prevent complications.

What foods should I avoid if I have IBD?

Dietary triggers can vary from person to person. Common irritants include high-fat or spicy foods, dairy products, raw vegetables, caffeine, and alcohol, especially during a flare-up. Additionally, a food, and symptom diary can help identify personal triggers. In some cases, a low-residue or low-FODMAP diet may be recommended.

Can stress cause an IBD flare-up?

Stress does not cause IBD, but it can worsen symptoms or trigger a flare. Managing stress through techniques like mindfulness, regular exercise, and adequate sleep can be beneficial alongside medical treatment.

Will I need surgery for IBD?

Not everyone with IBD needs surgery. However, it may be necessary if medications are ineffective or if complications such as strictures, fistulas or severe bleeding occur. In ulcerative colitis, surgery may offer a cure by removing the colon, whereas in Crohn’s disease, surgery may relieve symptoms but does not eliminate the disease.

Is IBD linked to colorectal cancer?

Yes, long-standing IBD, especially ulcerative colitis or Crohn’s disease involving the colon, is associated with an increased risk of colorectal cancer. Regular screening colonoscopies are recommended to detect early changes, and guide preventive care.

Can children or teenagers get IBD?

Yes, IBD can occur in children, and adolescents. In fact, around 25% of cases are diagnosed before the age of 20. Symptoms in younger patients may include delayed growth, puberty or poor weight gain, and early management is critical for healthy development.

Is it safe to get pregnant if I have IBD?

Most women with well-controlled IBD can have a healthy pregnancy. However, disease activity at the time of conception, and during pregnancy may affect outcomes. It is important to work closely with your doctor to manage your condition before, and during pregnancy.

Can IBD affect other parts of the body?

Yes, IBD can cause extra-intestinal symptoms such as joint pain, eye inflammation, skin rashes, and liver conditions. These symptoms may flare alongside gut inflammation, and require coordinated care.