When Should You See A Doctor For Your Gastric Pain?


December 11, 2019 Blog

Abdominal pain is a common health concern in children and adults. In fact, what people often term ‘stomachaches’ can arise from countless different problems, and not all originate from the stomach organ. Pain that arises from the stomach is typically felt as a pain in the centre of the upper abdomen, and more accurately termed ‘gastric pain’.

What causes gastric pain?

Ranging from a dull ache to a throbbing pain, gastric pain can arise from minor issues like flatulence (gas) and indigestion, or signal a more severe problem like gallstones or bowel obstruction. Here are some underlying issues that can result in gastric pain:

  • Flatulence (Gas)

Gas occurs naturally in the digestive tract due to the digestive processes. Sometimes, gas buildup causes a feeling of bloatedness, pressure, fullness, and mild pain. Usually, the pain comes in waves, and the abdomen may swell. Accompanied by burping or passing of gas, increased flatulence after eating certain foods is normal. Common flatulence-inducing foods include beans, garlic, and cauliflower.

Pain from gas is often fleeting and non-serious. If it is uncomfortable, some over-the-counter medications usually ease the pain and bloatedness quite quickly. However, if it occurs with fever, persistent vomiting or diarrhoea, or unbearable pain, a visit to the doctor is recommended.

  • Indigestion

The full, uncomfortable, burning sensation in the upper abdomen shortly after eating is often labelled as indigestion. Sometimes, the pain or burning feeling can also be felt in the mouth, throat, or chest. Also known as ‘dyspepsia’, indigestion is commonly the result of an acid buildup in the stomach. It can be caused by certain foods, or by eating too quickly.

In some cases, recurring indigestion may be a sign of underlying issues like acid reflux (e.g. GERD) or a stomach ulcer. If symptoms of indigestion occur frequently and are accompanied by severe pain or weight loss, a doctor’s advice may be required to help diagnose and manage the condition.

  • Stomach virus (stomach flu)

Although referred to as ‘stomach flu’, the stomach virus is not strictly a type of flu. Also called ‘gastroenteritis’, it typically manifests as nausea, vomiting, diarrhoea, and gastric pain. Some people may experience lethargy, headaches, or muscle aches as well. Most cases of gastroenteritis recover within a few days without medical intervention.

The key concern is to prevent dehydration. Thus, patients are usually advised to suck on ice chips, sip on water frequently, or consume an electrolyte drink. People with gastroenteritis should also avoid heavy meals and ease back into eating using foods that are easy to digest, like plain crackers, bananas, and toast.

  • Gallstones

When cholesterol or bilirubin forms solid particles in the gallbladder, these are called gallstones. Having gallstones that are small in size and number may not cause problems. However, large or numerous gallstones can result in symptoms like pain, vomiting, and fatigue.

The problems arising from gallstones happen when they form a blockage in the gallbladder. This can lead to impaired functions in the liver and pancreas, as well as jaundice. In some cases of gallstones, they are passed out naturally by the body. But in other cases, medication is needed to dissolve the stones, or a doctor may recommend surgical removal of the gallbladder.

  • Liver or pancreas issues

Sometimes, gastric pain arises from problems in the liver or pancreas. Inflammation of the liver (hepatitis) or pancreas (pancreatitis) often results in abdominal pain, hampered organ functions, and other symptoms. Although less often the case, upper abdominal pain may also be due to liver cancer or pancreatic cancer.

Other accompanying symptoms of liver or pancreas problems include yellowish eyes or skin (jaundice), nausea, vomiting, unusually dark urine, and pale or oily stools. Depending on the diagnosis, liver or pancreatic issues can be managed with lifestyle adjustments, medication, or surgical treatment.

  • Bowel obstruction

Bowel obstruction occurs when tissue blocks the intestinal pathway, hindering or completely blocking off the passage of digestive waste. It may be caused by an inflamed intestinal wall, fibrous scar tissues, or tumour growth (e.g. colon cancer). On top of intense pain and constipation, bowel obstruction can lead to vomiting of bile, abdominal swelling, and rapid weight loss. The pain is usually worse after eating.

Due to the risk of intestinal wall tearing or becoming infected, bowel obstruction is considered a medical emergency. An immediate visit to the hospital is required to provide medical intervention, pain relief, and if required, emergency surgery to remove the obstruction.

When should you visit a doctor for gastric pain?

While mild and occasional cases of gastric pain usually resolve itself, the more severe and recurrent cases require a visit to the doctor to diagnose the problem and recommend treatments. Here are some examples of gastric pain that should not be ignored:

  • Gastric pain accompanied by:
  • Persistent changes to bowel movement, e.g. pale, black, or bloody stools
  • Persistent diarrhoea or vomiting of more than 12 hours with no improvement
  • Fever
  • Rapid weight loss
  • Gastric pain in persons with weakened immune systems, e.g. young children, elderly persons, persons with auto-immune diseases like HIV, and persons with cancer
  • Gastric pain arising after injury or consumption of medication
  • Gastric pain that is extremely intense and debilitating

At the doctor’s, diagnosis methods may include an examination of your diet and lifestyle, imaging methods such as gastroscopy, colonoscopy or CT scans. Only then can the doctor ascertain the cause of your gastric pain and prescribe treatments to address the root problem.


November 22, 2019 Blog

Fatty liver is the umbrella term for the condition where liver cells contain more fats than is considered normal. Someone is considered to have fatty liver disease when the fat content in the liver exceeds 5-10% of the organ’s weight. Common risk factors for fatty liver are excessive alcohol intake and obesity.

At its early stages, fatty liver disease is a mild condition that often shows no symptoms. As such, many people live with fatty liver without having the condition diagnosed. Yet, fatty liver is not a disease to be simply glossed over. If left uncontrolled, fatty liver can escalate into serious and irreversible health problems down the road.

The potential complications of fatty liver disease are described below:

  • Liver inflammation and scarring: Direct effects of accumulated fats to the liver typically proceed in three stages – hepatitis, fibrosis, and cirrhosis.
    • Hepatitis is the inflammation of the liver caused by excess fats in the organ.
    • Fibros is refers to the scarring that occurs when the liver heals itself from the inflammation. If damage is persistent, the repeated healing process results in a thick buildup of fibrous scar tissue.
    • Cirrhosis is the later stage of fibrosis when the scarring has caused impeded functions in the liver.
  • Liver failure: When the liver has sustained enough damage to impair its functions, it is referred to as liver failure. Signs of a failing liver include jaundice, nausea, diarrhoea, fatigue, and hemorrhoids (piles), amongst others. In addition, more serious complications can arise due to liver failure, like internal bleeding and kidney failure.
  • Ascites: Referring to the buildup of fluid in the abdomen, ascites can occur due to liver scarring at the cirrhosis stage. As scar tissue builds up, it puts pressure on the walls of blood vessels, pushing liquid into the abdominal cavity. The swollen abdomen can lead to shortness of breath, restricted mobility, and a higher risk of infection and hernia.
  • Esophageal varices: These are swollen veins in the oesophagus that may arise from liver scarring. When scar tissue accumulates, blood flow to the liver is reduced, causing increased pressure in the blood vessels at the esophagus. It is considered a medical emergency if the esophageal varices rupture and bleed. Thus, patients with advanced liver disease should periodically be screened for the onset of swelling veins in the esophagus. Varices are usually diagnosed through endoscopy.
  • Increased risk of metabolic diseases: Fatty liver causes the overproduction of glucose and triglycerides, which are two key components of metabolic syndrome. With metabolic syndrome, there is also an increased risk of developing type 2 diabetes and heart diseases.
  • Increased risk of gastrointestinal cancers: Persons with fatty liver have shown a higher likelihood of developing cancers in the gastrointestinal tract, like liver cancer, pancreatic cancer, and colon cancer. Some studies estimate that the risk is 90% higher in fatty liver patients as compared to patients without the disease.

The good news is, fatty liver can be managed with some lifestyle changes before it compounds into a severe health issue. If you are at risk of developing fatty liver, or are already diagnosed with the condition, you can reduce the damage done to your liver by reducing your alcohol intake, adopting a healthier diet, and losing weight if you are overweight.



November 8, 2019 Blog

Fatty liver disease is a condition in which fats accumulate in liver cells. Two types exist – alcoholic fatty liver disease (AFLD) and non-alcohol fatty liver disease (NAFLD). As their names suggest, AFLD is triggered by excessive alcohol intake, whereas NAFLD is not. Instead, NAFLD is commonly associated with obesity, unhealthy diets, and sedentary lifestyles.

The incidence of fatty liver disease is on the rise worldwide and in Singapore. Some estimates put the prevalence of fatty liver in Singapore at 30-40%, which is higher than the world average of roughly 24%. If left untreated, fatty liver disease has the potential to escalate into fibrosis and cirrhosis, which impair the functions of the liver. This can ultimately lead to liver failure and liver cancer.

How does diet play a part in liver health?

As a significant contributor to fatty liver disease is diet, one of the primary ways to combat it is by altering one’s diet to a healthier one. An appropriate diet can help with weight loss, which reduces the risk factor of attaining liver disease. In individuals with the disease, a drop in weight of 10% is significant enough to decrease liver enzyme to healthier levels.

A balanced diet will help the liver receive the necessary nutrients it needs to operate smoothly. Thus, a liver-healthy diet will also be beneficial for overall liver health, reducing the risk factors for liver diseases, and benefitting patients with other liver conditions like hepatitis B and C.

In general, the recommended diet for optimal liver health is one that is low-fat, reduced in calories and high in fibre. Below are some recommendations of foods to include and to avoid in your diet.

Foods to include:

  • Cruciferous vegetables: Greens like broccoli, cauliflower, cabbage, kale, and Brussels sprout contain glutathione, a compound that promotes the detox functions of the liver. These fibre-rich vegetables also give a feeling of fullness, which prevents overeating and helps with weight loss.
  • Fatty fish: Fish like salmon, tuna, trout, and sardines are packed with omega-3 fatty acids, which are considered healthy fats. Omega-3 fatty acids have been found to lower fat levels in the liver and reduce inflammation. As an alternative to other meats, it can reduce consumption of unsaturated fats from other meat sources.
  • Nuts & seeds: Almonds and sunflower seeds are sources of vitamin E, an antioxidant that has been associated with improved liver health. Walnuts contain omega-3 fatty acids, glutathione, as well as arginine, an amino acid which assists liver cleansing processes.
  • Cold-pressed, organic oils: Olive oil, hemp oil, and flaxseed oil are high in omega-3 fatty acids, and are healthier alternatives to butter, margarine and vegetable oil. The unsaturated fat content helps to reduce liver enzyme and fat levels in the liver.
  • Garlic: The popular herb contains sulfur and selenium, which are known to help the liver remove toxins and boost antioxidant levels in the liver. Garlic also flavours food, reducing the amount of unhealthy seasoning like salt and sauces that would be added otherwise.
  • Low-fat dairy: The protein in milk helps in tissue reparation, and protects the liver from damage. For a healthier option, opt for skimmed or fat-free milk.
  • Coffee & tea: Caffeine has been found to bring unhealthy liver enzyme levels down. Green tea also contains catechin, an antioxidant that assists liver function. Some studies find that green tea can also reduce fat levels in the liver.

Foods to avoid:

  • Alcohol: The main contributor to AFLD and numerous other liver diseases is excessive alcohol intake. Alcohol in the body damages liver cells, and over-consumption can cause inflammation and scarring. Alcohol also causes the body to store more fats, contributing to fatty liver.
  • Added sugar: High blood sugar leads to increased fat buildup in the body, including at the liver. Sugary foods to avoid include cakes, cookies, candies, and sweet drinks.
  • Fried food: Due to the amount of oil used in frying, these foods are typically high in fat and calories. Thus, they do no good to health and are huge contributors to weight gain.
  • Salt: Heavy sodium intake can damage the liver by causing inflammation and cell death. For a healthy diet, the recommended daily intake of sodium should not exceed 1,500 milligrams.
  • Processed grains: White rice, pasta, and bread are made of highly processed grains, which have a higher glycemic index (GI) than its less-processed counterparts. High GI foods lack fibre and raise blood sugar, leading to fat buildup and weight gain.

As with all diet recommendations, consistence and moderation are paramount to its success. If you are at high risk of liver disease or have already been diagnosed with a liver condition, you should speak to your doctor about a personalised diet plan.



October 31, 2019 Blog

Pancreatic cancer is known as a silent but deadly illness because symptoms are rarely noticed until it has reached an incurable stage. At an estimated 2% incidence rate in Singapore, pancreatic cancer itself is not a common cancer. However, there is a high mortality rate for those diagnosed with the disease, making it one of the top cancers to take lives in Singapore.

Symptoms of pancreatic cancer

The key to battling pancreatic cancer is to spot it early and have it treated as soon as possible. However, early-stage pancreatic cancer is known to have unnoticeable or vague symptoms. The safest way to go about it is to know your own body. If any of these symptoms arise unusually and cannot be traced to other known conditions, it is always best to go to a doctor for a thorough checkup.

As a guide, here are the common symptoms of pancreatic cancer:

  • Poor appetite and weight loss: As the pancreas is an integral part of the digestive system, the impaired function of the pancreas often results in poor digestion. This manifests as malnutrition, declining weight, and lack of appetite.
  • Abdominal bloating: Digestive problems also cause gas build-up from undigested food in the digestive tract. Pancreatic cancer may also cause ascites, which is a build-up of fluid in the abdomen, making the tummy area appear swollen.
  • Nausea and vomiting: As the tumour grows larger, it can block part of the digestive tract and impede digestive functions. This causes fluids to back up in the digestive system and leads to nausea and vomiting symptoms.
  • Pale/greasy stools: When the pancreas’ function is compromised, it has problems digesting nutrients. Undigested fats are excreted in the stools, causing the appearance of pale and oily stools. Malabsorption can also contribute to diarrhoea and/or constipation.
  • Back pain and abdominal painIf the tumour grows in a location that presses against nerves or other surrounding organs, patients may feel pain at the back or abdomen area.
  • Jaundice: The natural breakdown of aged red blood cells turns them into bilirubin. When bilirubin pigment builds up, it causes skin and whites of the eyes to yellow. Normally, bilirubin is broken down by bile, but when the tumour obstructs the flow of the bile duct, the digestion of bilirubin can be hindered, thus causing jaundice.

Diagnosis methods for pancreatic cancer

While it is difficult to pinpoint pancreatic cancer from its symptoms, some people are fortunate to have the tumour detected early from other health examinations and diagnostic tests. Several scanning methods are able to visually identify growths on the pancreas. If you or your doctor suspect any abnormalities in your pancreas, here are some examinations your doctor may recommend:

  • CT scan: Computer tomography is a method of X-ray that compiles multiple scans of the body at varying depths to give a ‘3-D’ perspective of the body tissues. Suitable for almost any part of the body, it can be used to visually check for abnormal growths on the pancreas.
  • MRI: Magnetic resonance imaging uses magnetic waves to produce detailed images of organs and structures inside the body. It gives more high-definition images than CT scans but is also more expensive.
  • PET scan: Positron Emission Tomography involves the injection of radioactive fluid into the body. As the fluid travels in the bloodstream to different organs, it shows up more prominently on the X-ray scan. This method can be combined with a CT scan to better visualise the tumour growth and affected areas.

These images are helpful for detecting growths on the pancreas, but cannot determine if the tumour is cancerous. To confirm the nature of the tumour, the doctor needs to obtain a small sample of tissue from the tumour for analysis. This procedure is called a biopsy. Your doctor may conduct a biopsy of one of the following types:

  • FNA: Fine needle aspiration involves the insertion of a fine needle with an attached syringe into the body. The method is performed with the assistance of an imaging scan (MRI, CT scan, or ultrasound), and is used to obtain tissue samples from the target organ – in this case, the pancreas.
  • ERCP: Endoscopic retrograde cholangiopancreatography is a form of endoscopy where a long flexible tube is inserted through the oral cavity to the small intestine, near the pancreas. Medical instruments can pass through the endoscope to take images and tissue samples.
  • EUS: Endoscopic ultrasound is similar to ERCP in that it utilises an endoscope to reach the intestines. In EUS, a small ultrasound device is attached at the tip of the endoscope, allowing for a better view of the digestive tract and pancreas. A small needle on the endoscope may be used to retrieve tissue, or the EUS can be used in conjunction with FNA.

These diagnostic tests can typically be carried out on an outpatient basis at hospitals or specialist clinics. As performing these procedures require specialised training, you will need to find doctors who are certified and well-reputed in these techniques. For example, ERCP and EUS should only be performed by a doctor trained in advanced endoscopy in Singapore.

Recent advancements in pancreatic cancer diagnosis

In more recent advancements, medical researchers have found success in using blood tests as a diagnosis method for pancreatic cancer. While the existing blood test for Ca 19-9 is not a reliable test for pancreatic cancer, new blood tests for other markers in the blood have been shown to have better accuracy rates in diagnosing pancreatic cancer. Although it may take some time for this new method to become better established and available in the market, it offers hope for a reliable, non-invasive diagnostic test for pancreatic cancer in the near future.


An awareness of the symptoms of pancreatic cancer is crucial for defending oneself against the illness. If you observe any abnormalities in your digestive health, or are a high-risk individual for pancreatic cancer, you may want to consult a gastroenterologist for a thorough examination. Your doctor can provide you with further information about pancreatic cancer and its costs.


October 23, 2019 Blog

It is well-known that excessive alcohol consumption is detrimental to liver health. However, obesity is also a significant contributor to liver conditions.

What is obesity?

Obesity is the condition of having excess fat in the body. A normal amount of body fat percentage is 25-30% in women and 18-23% in men – any body fat percentage over the normal range is an indication of obesity. Some people prefer using the body-mass index (BMI) as an indicator of body fat, as it is easier to measure without specialised equipment, although it is less accurate. As a general indication, a person with a BMI of 30 and above is considered to be obese.

For a while now, doctors over the world have been labelling obesity as an epidemic. Perpetuated by sedentary lifestyles and poor diets, the condition is affecting vast populations in developed nations around the world. Obesity is worrisome as it is a contributor to many types of health conditions, such as type 2 diabetes, coronary heart disease, high blood pressure, higher risk of strokes, gout, gallstones, colon cancer, and fatty liver disease.

How does obesity affect liver health?

A range of liver diseases under the name non-alcoholic fatty liver disease (NAFLD) is caused by obesity. Statistics place NAFLD as the most common liver disease worldwide, affecting 10-24% of the world’s population. While the exact mechanism by which obesity leads to liver disease is not known, it is commonly thought that obesity contributes to insulin resistance, which in turn causes the onset of these liver conditions.

NAFLD and obesity are also closely tied in terms of the degree of liver damage. This means that a higher obesity or higher BMI typically leads to greater liver damage. The range of conditions under NAFLD can be classified in varying stages of severity. These are listed in increasing order below:

  • Simple fatty liver (steatosis): Steatosis is a build-up of excess fat (more than 5%) in the liver. This condition usually shows no symptoms and is diagnosed incidentally when tests for other conditions are being conducted.
  • Non-alcoholic steatohepatitis (NASH): NASH is a more advanced form of NAFLD in which inflammation occurs in the liver. However, it is still relatively low-grade and many people live with it with little or no symptoms for years.
  • Fibrosis:When liver inflammation persists, scar tissue is repeatedly formed and builds up around the liver and surrounding blood vessels. Although the condition is more serious, the liver can still function at this stage.
  • Cirrhosis:After years of inflammation, the liver starts to shrink and becomes scarred and lumpy. At the most severe form of NAFLD, liver damage is permanent and can lead to failure of liver functions and liver cancer. Other condition,  such as infections of hepatitis B and hepatitis C, can also lead to cirrhosis.

How is NAFLD diagnosed?

NAFLD at its early stages does not show any symptoms. If any, the symptoms reported are non-specific, such as lethargy, nausea, or a dull ache at the right abdomen under the ribs. Thus, NAFLD is usually only spotted during other routine tests or examinations for other conditions. For example, routine blood tests may show up with elevated levels of liver enzymes, prompting a diagnosis for NAFLD. Ultrasound examination of the abdomen for other purposes can also detect fatty liver.

As the disease progresses in severity, more symptoms will start to show up. At the cirrhosis stage, symptoms can range from swelling of the legs, bleeding from esophagal veins, accumulation of fluid in the abdomen, and mental confusion.

Who is at risk of NAFLD?

Certain lifestyle factors and pre-existing health conditions can put one at higher risk of contracting NAFLD. These are:

  • Obesity, especially if fats are concentrated at the visceral area
  • Type 2 diabetes
  • High blood pressure
  • High cholesterol
  • Metabolic syndrome (a combination of diabetes, high blood pressure and obesity)
  • Age of 50 years and above
  • Smoking

What can you do to reduce the risk factors?

If you are already obese, you can reduce your chances of developing NAFLD by losing weight. You can do this through exercising and maintaining a healthy diet. Ideally, this means reducing your consumption of refined carbs, opting instead to eat wholegrain foods, and foods that are low in sugar and fat.

For those who are already diagnosed with NAFLD, losing weight is also the primary treatment method to prevent further deterioration and promote recovery. A 10% weight loss is enough to lead to a significant drop in liver enzyme levels. However, care should be taken not to undergo extreme diets that lead to a drastic reduction in weight, as this puts extra stress on the liver and other parts of the body.

As can be seen, obesity is a major contributor to liver disease. Take care of your liver health by taking steps to maintain a healthy weight and active lifestyle. To learn more about liver diseases, you may consult a gastroenterology specialist for a personalised consultation.


October 4, 2019 Blog0

Bowel movement is a natural process that all humans undergo to eliminate wastes from the body. While some may dismiss it as a daily inconvenience, the appearance of one’s stools can be a useful indicator of one’s gastrointestinal health. Thus, it is good to have an idea of the different kinds of stools and what they tell you about your health.

What are stools?

Faeces excreted from the body consist of undigested food, proteins, bacteria, salts, and various other chemicals from the intestines. The appearance and smell of stools differ from person to person, although there are some characteristic trends for healthy and unhealthy faeces.

  •    Healthy stools

Healthy bowel movement should be easy and painless to pass. Normal stools should be log-shaped, brown to greenish in colour, and soft to firm in consistency.

Between 3 times a week up to 3 times a day is considered a normal frequency for passing stools. As this frequency varies from person to person, anything out of one’s usual routine can be a sign of something being amiss.

  •    Hard, lumpy stools

Small, pellet-shaped stools that require straining to pass is usually an indication of constipation. Constipation can be caused by a number of issues, such as stress, irritable bowel syndrome (IBS), and certain medications. However, in otherwise healthy individuals, hard, lumpy stools are likely to be a consequence of a lack of fibre. This problem can be solved by increasing the intake of dietary fibre and drinking more water.

  •    Very loose stools

Formless or watery stools, otherwise known as diarrhoea, can be a symptom of various conditions, such as food poisoning and stomach flu. Prolonged diarrhoea lasting more than a few days can be a sign of more serious issues like IBS, Crohn’s disease, or celiac disease.

Aside from getting to the root cause of diarrhoea, persons suffering from it should take extra care to stay hydrated by drinking water and electrolyte drinks, to counter dehydration and malabsorption of nutrients.

  •    Strange-smelling stools

Faeces naturally smell unpleasant due to the fermentation process that occurs in the intestines. However, stools that smell exceptionally foul may signal malabsorption of nutrients, causing excessive fermentation of undigested food. This could be a warning sign for conditions such as celiac disease, bacterial infections, or food intolerances.

  •    Blood in stools

Blood in stools can appear as red or black stools. Red stools may indicate bleeding in the lower intestinal tract, or bleeding due to hemorrhoids. A less alarming cause of red-tinted stools may be coloured foods consumed recently, such as beetroot, cranberries, or tomato juice.

Similarly, black stools may indicate bleeding in the upper gastrointestinal tract, or be due to foods such as licorice, iron supplements, or bismuth medications. To ascertain if it is blood in your stools, first rule out the possibility of these foods being the cause of your red or black stools.

While the occurrence of hemorrhoids in Singapore is common and usually non-serious, blood in stools may signal a more serious problem that is worth a visit to your doctor sooner rather than later.

  •    Fatty, oily stools

Stools sometimes appear stinky, yellowish, and greasy due to high fat content. As a result, these oil-slicked stools tend to float rather than sink. This type of stools is a sign that the body is not absorbing fats from food properly, which may be contributed by pancreatic conditions, a gastrointestinal infection, or cystic fibrosis.

If these symptoms last for more than a few days, a visit to the doctor will be helpful to ascertain the cause of oily stools. While acute pancreatitis is usually short-lived and treatable, chronic cases cause prolonged discomfort and may increase the chances of contracting pancreatic cancer. You doctor will be able to advise you on relevant information such as options for pancreatitis or pancreatic cancer treatment in Singapore.

What should you do if you detect unusual changes in your stool?

Fleeting changes in stool appearance are normal in healthy persons, dependent on the day-to-day activities and diet of the individual. It only becomes a cause for concern when these unusual symptoms persist for more than a few days, or occurs alongside pain or other symptoms. A more urgent case is blood in stools – these should be checked out by your doctor if the bleeding lasts for more than two days without an apparent cause.

The first course of action when investigating unusual stools is to consult your doctor, who may refer you to a gastroenterologist specialist. To diagnose your condition, you may be required to provide a stool sample for clinical testing. Further examinations like an endoscopy may also be performed. After diagnosing the state of your health, the gastroenterologist can then dispense you advise for suitable treatments.


September 26, 2019 Blog

Alcohol abuse is commonly associated with liver problems because the liver is the organ mainly responsible for metabolising alcohol in the body. When there is excessive alcohol intake, the liver is unable to keep up with processing of the alcohol and causes it to remain in the body. The more alcohol is consumed, the greater the risk of damage to the liver. These damages can occur in the form of fatty liver, alcohol hepatitis, and cirrhosis.

However, it is less common knowledge that heavy alcohol use also affects the pancreas. In the US, some statistics put the proportion of pancreatitis sufferers who are also heavy alcohol users at 70%. It is well established in the medical field that there is a link between excessive alcohol intake and pancreatic-related health conditions.


Pancreatitis is a condition where the pancreas becomes inflamed. It is one of the main pancreatic illnesses that alcohol abuse is associated with. The inflammation of the organ impacts the metabolic functions of the pancreas, which cause further health complications. Clinical records put men in their 40s with a history of heavy alcohol consumption as at highest risk of being diagnosed with pancreatitis.

Although researchers have not confirmed the exact mechanism by which alcohol affects the pancreas, one theory postulates that alcohol induces digestive enzymes to flow back into the pancreas instead of being released into the intestines. As a result, the enzymes attack the pancreas cells themselves. Another theory proposed that alcohol incites a backflow of bile, thus damaging the pancreas.

Pancreatitis occurs in two forms: acute pancreatitis and chronic pancreatitis. While both are inflammations to the pancreas, they differ in the duration and severity of the conditions.

  •    Acute pancreatitis

Acute pancreatitis is a short-term and sudden inflammation of the pancreas. Symptoms include abdominal pain near the back behind the ribs, nausea, vomiting, and fever. Symptoms usually only last a few days, and most patients recover quickly without major complications. However, in rare cases, it can also become fatal. Severe cases of acute pancreatitis can also cause further complications like internal bleeding, irreparable tissue damage, infection, formation of cysts, and damage to other organs.

While most cases of acute pancreatitis usually resolve quickly without leaving lasting damages, continued excessive drinking can cause repeated bouts of acute pancreatitis. Recurring acute pancreatitis can then evolve into a chronic condition of the inflammation of the pancreas.

  •    Chronic pancreatitis

Chronic pancreatitis occurs when there is long-term inflammation of the pancreas, which usually happens only after periods of acute pancreatitis. At this stage, the damage to the pancreas is irreparable, and symptoms are experienced on a long-term basis. Symptoms include recurring pain near the back behind the ribs, weight loss, greasy stools, and jaundice. Chronic pancreatitis typically does not heal, but only gets worse gradually.

While chronic pancreatitis is usually not immediately life-threatening, it can lead to further health complications. For example, the loss of function in the pancreas leads to digestion problems and diabetes.

Complications arising from pancreatitis

  •    Diabetes

Chronic pancreatitis can lead to diabetes because the pancreas can no longer function to produce insulin. About one-third of chronic pancreatitis patients develop diabetes later in life. The onset of diabetes for pancreatitis patients usually occurs only years after the diagnosis of pancreatitis.

  •    Pseudocysts

Chronic pancreatitis can also lead to the growth of cysts or pseudocysts. These growths are fluid-filled sacs that form on the surface of the pancreas. They are formed by localised masses of dead tissue and old blood. Some cases of pseudocysts do not show symptoms, however, some patients report bloating, indigestion, and abdominal pain resulting from these cysts.

Pancreatic cysts may cause infections to the pancreas and nearby organs. In some cases, the cyst may be cancerous or pre-cancerous, developing into malignant tumours later on.

  •    Pancreatic cancer

Pancreatic cancer is when a tumour grows on a part of the pancreas, thus affecting the function of the pancreas. Studies show a link between heavy alcohol usage and pancreatic cancer, and between those with a history of pancreatitis and those who develop the cancer. One pathway for this development is the cysts that form as a complication in chronic pancreatitis.

How can you guard yourself against pancreatic conditions?

Pancreatic conditions are potentially very painful and costly illnesses. Not only might you have to deal with the substantial pancreatic cancer treatment cost, but you will also have to suffer in your quality of life. It will be worth it to reduce your likelihood of developing these pancreatic conditions and complications by regulating your alcohol intake.

Even if you have been diagnosed with acute pancreatitis before, you can lower your chances of suffering from acute pancreatitis again and from developing the chronic condition by keeping a low rate of alcohol intake and a low-fat diet. For those currently battling pancreatitis, abstinence from alcohol will help to reduce pain and allow your pancreas to heal.

If you are a heavy alcohol user, you should consider taking measures to regulate your drinking habits. To find out more about the risks of alcohol drinking to your pancreas health, consult a gastroenterology specialist today.


September 4, 2019 Blog

Pancreatic Cancer Treatment Cost Singapore, Vomiting Symptoms

Pancreatic cancer is the 5th and 6th most common cancer to take lives in men and women in Singapore, respectively. More than 80% of cases cannot be fully treated by the time of diagnosis. About 5% of pancreatic cancer patients live beyond five years, but only 1% survive beyond ten years. What is pancreatic cancer, and why is it so lethal?

What is pancreatic cancer?

The pancreas is an organ located in the upper abdomen, in between the stomach and the spine. The organ has two functions, which is to secrete enzymes to digest fats, proteins, and carbohydrates (exocrine function); and to produce insulin and glucagon to regulate blood sugar levels (endocrine function).

Pancreatic cancer occurs when a tumour grows in part of the pancreas, hindering the normal function of the pancreas. In advanced stages of the illness, the growth of the tumour can also metastasise (spread) to other parts of the body, which makes total removal of cancer cells close to impossible.

There are two main types of pancreatic cancer, depending on which part of the pancreas the tumour begins to grow in. The more common and also more aggressive type is the exocrine pancreatic cancer, wherein the tumour affects the exocrine function of the pancreas. The less common variant is the endocrine pancreatic cancer, in which the tumour affects the endocrine function of the pancreas.

Why is pancreatic cancer so lethal?

Pancreatic cancer is said to be an aggressive and deadly illness because most of the patients who are diagnosed have little chance of survival. Here are some of the reasons why pancreatic cancer offers little hope for patients:

  • There is no known cause: There is no known cause for pancreatic cancer, making it difficult to identify people who are at-risk. While there are some factors found to have correlations to pancreatic cancer, such as a family history of pancreatic illness, smoking, and obesity, these are still much too general to effectively predict or narrow down people at risk of developing pancreatic cancer, such that early diagnosis can be made.
  • Symptoms are non-specific: Doctors list the symptoms of pancreatic cancer to be upper abdomen pain, jaundice, poor appetite, nausea, vomiting, weight loss, malnutrition, and pale greasy stools, amongst others. However, these symptoms vary from case to case and are not specific to pancreatic cancer. This makes it difficult to immediately pinpoint the cause of symptoms to pancreatic cancer.
  • Symptoms arise when its already too late: Most cases of pancreatic cancer are diagnosed when it is already too late to be cured. This is because symptoms of pancreatic cancer often only arise at the later stages of cancer when the tumour has already grown quite large. At this point, the growth would have infiltrated nearby organs such as biliary ducts, liver, surrounding lymph nodes, blood vessels and bones, making it impossible to remove at the time of diagnosis.
  • There is no reliable screening method: Unlike breast cancer or colon cancer where diagnosis tests are relatively reliable and accessible, pancreatic cancer lacks a reliable and widely available test for the masses to conduct regular checks. This makes it difficult to detect pancreatic cancer at the early stages when it is still curable.

Unfortunately, pancreatic cancer continues to take lives with warnings that are too little and too late. What you can do is to maintain a healthy lifestyle to reduce the risk factors of pancreatic cancer, and keep a lookout for warning signs. If you would like to know more about pancreatic cancer, you can consult a gastroenterologist specialist to tell you more about its symptoms, diagnosis methods, and treatment options.


August 15, 2019 Blog


Have you been experiencing pain when passing stools, itching in your anal area, swelling or soreness in your bottoms, or bleeding in your stools? These are common symptoms for hemorrhoids, or piles, and can make the everyday affair of defecation a painful one. Hemorrhoids are the medical condition of swollen veins in or around the anus and lower rectum. Most cases of piles are minor and go away without further medical intervention. However, if the symptoms persist beyond 1-2 weeks, it is advisable to visit a gastroenterologist to rule out other serious problems and consider appropriate medical treatment to deal with the hemorrhoids.

Whether you are awaiting further treatment, or are advised to wait out the symptoms, it can be agonising living with the pain and discomfort of having piles. Measures that prevent hemorrhoids are also effective methods for piles treatment. These include having sufficient water intake, and not resisting the urge to empty your bowels. Apart from these, there are also numerous home remedies for piles you can try if you are already suffering from painful hemorrhoids: 

  • Soothing wipes

Toilet paper tends to be rough and may further irritate the tender sores on your bottom. Instead, try using soothing wet wipes to clean up after bowel movement. The moisture of the wipes serves as lubrication, so they are gentler on the skin. Look for wipes with witch hazel or aloe vera, as these have soothing and anti-inflammatory properties. However, keep away from wipes containing alcohol or perfume, as these are irritants that may exacerbate your condition.

  • Take warm baths

Warm baths are a quick and easy way to soothe skin irritations. Harvard Health recommends a 20-minute warm bath after each bowel movement for effective results. A fuss-free way is to use a sitz bath, a small plastic tub that attaches over your toilet seat, by filling it with a few inches of water to soak your bum. After every bath, make sure to dry off thoroughly by gently patting with a soft towel or using a hair dryer. This prevents the accumulation of moisture that promotes the development of unwelcome bacterial or fungal infections.

  • Cold compress

Application of ice packs or cold compresses are known to aid in pain relief and shrinking of sores. Hold the cold compress or ice pack against the affected area for up to 15 minutes at a time. To minimise the risk of ice burn, always wrap any frozen objects in a towel before applying to the skin.

  • Stool softeners

To make stool less painful to pass, stool softeners can help to make bowel movements smoother and quicker. Stool softeners, also called emollient laxatives, come in various forms like powders, capsules, or liquids, and are readily available as over-the-counter medications.

  • Increase fibre intake

Dietary fibre and fluids intake are crucial for promoting bowel movement, which reduces the need to over-strain when passing stool. Simple dietary changes or supplements can help to increase dietary fibre intake and relieve constipation. Some high-fibre foods to add to your diet include wholegrain-based foods, fruits and vegetables, peas, beans, and nuts. Take care to make these dietary adjustments gradually, as sudden overconsumption of fibre may cause excessive gas and bloating.

What to do if your symptoms persist

Piles are a common and usually mild affliction, but in rare cases where your symptoms persists, it could signal something more serious. Your doctor may recommend performing further checks such as a digital rectal examination and possibly a colonoscopy to give a more detailed diagnosis. If the condition requires, your gastroenterologist will advise you on appropriate medical procedures available to you, which may include rubber band ligation, or hemorrhoid stapling. It is recommended you make an appointment with a specialist in gastroenterology to access the needs of your condition.


August 7, 2019 Blog

Endoscopy Symptoms

An endoscopy is a nonsurgical procedure that involves inserting a long, thin tube directly into the body, commonly through the mouth or anus, to make observations on an organ or tissue in detail. The flexible tube has a camera and light attached to it so the doctor can visually examine your digestive tract on the TV monitor.

Through the endoscopy procedure, the doctor can evaluate and diagnose certain the cause of symptoms and therefore, recommend the appropriate treatment. It can also be used to carry out treatment directly and avoid the need for further surgery.

Different types of endoscopy

Gastroenterology specialists are specialized in endoscopy and they are the ones who will perform it. It can be a useful procedure to help in a broad array of medical conditions related to all parts of the digestive tract. There are generally 2 groups of digestive endoscopies.

General endoscopy helps to evaluate most digestive symptoms and recommend treatment, including procedures like:

  • Gastroscopy: Esophagus, stomach and small intestine (duodenum)
  • Colonoscopy: Large intestine and colon

Advanced endoscopy includes more complicated endoscopy types with higher risks of complications but often help patients avoid a more invasive surgery, namely:

  • ERCP (Endoscopic Retrograde Cholangio-Pancreatography): Bile ducts and pancreatic ducts
  • Endoscopic ultrasound (EUS): The gastrointestinal (GI) tract and neighbouring organs

When will you need an endoscopy

There are mainly three reasons when endoscopy will be recommended to you.

1. Investigate symptoms and signs

Your doctor can take a look and investigate digestive signs and symptoms like persistent abdominal pain, difficulty in swallowing (dysphagia), change of bowel habits, blood in stools and gastrointestinal bleeding.

2. Diagnose

A biopsy can be carried out using endoscopy to collect tissue samples and test for conditions and diseases such as ulcers, digestive tract bleeding, polyps or growths in the colon to prevent the development of colon cancer.

3. Treatment

It may also be used to treat problems in the digestive tract. Special tools and devices can be passed through the endoscope to remove bile stones, for example. If polyps are found in the colon, they can also be removed through endoscopy with standard polypectomy techniques. for the prevention of colon cancer development.

How to prepare for the procedure

Your doctor will share specific instructions in preparation for the endoscopy. Typically, you will need to fast for about 8 to 12 hours before the endoscopy so your stomach will be empty for the effectiveness of the procedure. Laxatives may also be taken on the previous night to clear your system for procedures investigating the gut. Remember to mention the supplements and medications you are currently taking so your doctor will advise you accordingly to stop taking or continue as per normal.

During the procedure

The procedure is usually an hour-long duration and won’t require an overnight hospital stay. A local anaesthetic is applied to numb a specific area of your body, such as the back of your throat. The endoscope will be inserted into your body openings, which depends on the examined area, i.e. throat, anus, or urethra. For insertion through the mouth, you will be asked to wear a mouth guard to protect the lips and teeth, and hold your mouth open.

You may feel some pressure during the insertion but generally, you shouldn’t feel pain. Images will be transmitted to the monitor for your doctor to view and look for abnormalities. Gentle air pressure may be added into your esophagus to allow the endoscope to move freely and examine your digestive tract easily.

A sedative will also be given to patients to help them to relax and be more comfortable, and have a good experience when going through the endoscopic examination. During the procedure, patients will not feel or remember the process but your doctor will ensure it is performed safely with adequate monitoring.

Due to the sedative, your judgement, reaction times, and memory may be impaired. Thus, arrange for someone to drive you home afterwards and plan for an additional 24 hours for the sedative effects to wear off before resuming work or other activities.

The risks and possible side effects

After endoscopy, you may experience mildly uncomfortable symptoms such as sore throat, cramping, bloating and gas. It is a relatively safe procedure with a low risk of serious complications. However, if you experience symptoms like shortness of breath, chest pain, vomiting blood, severe and persistent abdominal pain, it should be reported to a doctor.

Possible complications can include a minor infection in the area of investigation, persistent pain experienced in the endoscopy area, perforation (tearing) of an organ or internal bleeding.

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