digestive illnesses | gutCARE

Inflammatory Bowel Disease (Crohn’s disease and ulcerative colitis)

April 6, 2021

IBD Treatment Singapore

Inflammatory Bowel Disease is a chronic condition characterised by intermittent inflammation of your digestive tract. There are 2 main types of Inflammatory Bowel Disease: Crohn’s disease (CD) and Ulcerative Colitis (UC). In Crohn’s disease, inflammation may occur at any part of the digestive tract from the mouth, down the digestive tract till the anus. In ulcerative colitis, inflammation is usually restricted to the large intestine only. 


Inflammatory Bowel Disease is an immune mediated disease of the digestive tract. While immune system normally helps in fighting infection that intrudes our body, this balance is lost in patients with IBD. Instead, it attacks the intestine resulting in intermittent inflammation. Exact cause is not known. While various causes have been speculated, it is likely a combination of factors including genetic, environmental factors such as diet, lifestyle; and changes of bacteria flora in the digestive tracts. 

Risk Factors

People with certain risk factors may carry a higher risk of developing Inflammatory Bowel Disease. This includes:

1. Positive family history: Certain genes may increase the risk of a person having Inflammatory Bowel Disease. However, most patients do not have a positive family history. 

2.Race and ethnicity: Whites especially Jewish generally have higher risk than non-whites or non-Jewish population to develop Inflammatory Bowel Disease. 

3. Smoking: Smoking is associated with increased risk of Crohn’s disease but not ulcerative colitis. It is also associated with increased risk of recurrent flares, severity and needs for surgery.


Inflammatory Bowel Disease should not be confused with Irritable Bowel Syndrome where symptoms are driven by the bowel being over sensitive rather than from active inflammation, as seen in patients with IBD. 

Common symptoms of both Crohn’s disease and ulcerative colitis include:

  • Diarrhoea
  • Blood in stool
  • Abdominal pain
  • Fever
  • Weight loss

Patients with Inflammatory Bowel Disease may occasionally have involvement of other parts of the body. This may result in symptoms including:

  • Mouth ulcers
  • Rashes
  • Eye involvement
  • Joint pain
  • Jaundice (body turning yellow) from liver involvement


Chronic inflammation of the large intestine, especially when extensive, is associated with increased risk of colon cancer. 

Other complications specific for Crohn’s disease:

Stricture (narrowing of the intestine). 

This occurs when there are accumulation of scars from recurrent inflammation, resulting in swelling and narrowing of the intestine. Patients often noticed symptoms of obstruction such as pain or vomiting. 


Fistula refers to abnormal connection between 2 organs. These usually occur in Crohn’s disease when there is extensive inflammation through the intestinal wall forming a track with another organ.

Complication specific for Ulcerative colitis:

Toxic megacolon

This is a rare condition that usually occurs when there is extensive inflammation of the large intestine, resulting in abnormal swelling and high risk of perforation.


Diagnosis of Inflammatory Bowel Disease is usually made once a patient has compatible clinical history, typical appearance when inspected using endoscopy, and biopsy results. 


Your doctor may need to do some blood tests, stool tests, endoscopy and occasionally scans. This allows your doctor to confirm the diagnosis of Inflammatory Bowel Disease; exclude other conditions that may mimic appearance of Inflammatory Bowel Disease (such as irritable bowel syndrome, infection, cancer and etc); as well as to stage the extent and severity of your disease. 



Dietary management is crucial in patients with Inflammatory Bowel Disease as patients are often malnourished due to poor appetite, pain, malabsorption from active disease or previous bowel surgery.

While certain food may worsen symptoms during active flare, there is inconclusive evidence that any particular diet that may worsen the inflammation. 

Exclusive enteral nutrition using only liquid diet has been shown to be an effective alternative in children with active Crohn’s disease. It is generally favoured as a first line treatment as it minimises use of steroid in the children. Role of exclusive enteral nutrition to control disease in adult Crohn’s disease is however less certain. 

Fibre should generally be avoided in small group of Crohn’s disease patients with intestinal narrowing. Other than this, it should not be restricted in most Crohn’s and ulcerative colitis patients as it may have a beneficial effect on the micro bacteria in the intestine. 


Probiotics are living, non pathogenic microorganisms that are commonly used to contribute to the intestinal health of a person. While probiotics improves symptoms from irritable bowel syndrome, available data do not support use of probiotics in healing Crohn’s disease or ulcerative colitis. 


Medications used for Inflammatory Bowel Disease aim to heal the inflammation, and maintain the disease in remission. While there are various medications that can be used to reduce the inflammation, they work through different mechanisms. This explains the difference in efficacy, rate of response, and side effects. Choices of which medication to be used often depend on the extent and the severity of the disease. Given that this is a chronic condition with no available cure, most patients need to be on some form of maintenance medication long term to keep the disease under control.


Steroid is very effective in reducing inflammation rapidly. However, due to the risk of side effects, this medication is usually used only for a short term rather than as a maintenance medication. 


Active compound of mesalazine is 5- aminosalicylate acid (5-ASA), which exert a topical effect in reducing the inflammation. This is usually the first line medication used for ulcerative colitis, and less commonly, in a small subset of Crohn’s disease with mild disease. This medication is usually well tolerated, and used as long term maintenance medication. 


Immunomodulator are usually used when the disease does not respond to mesalazine, or require repeated courses of steroid. Commonly used immunomodulators are thiopurine (azathioprine, 6 mercaptopurine) or methotrexate. Unlike steroid, this can be used for long term maintenance with a favourable side effect profile. 


Biologic is a special class of medication that is given through injection as it is made from protein. Biologics are generally more effective and are therefore reserved for patients with more severe disease who do not respond to conventional treatment including immunomodulator or mesalazine. 

Commercially available biologics include:

BiologicsLicensed for
Anti-TNF agents
                       InfliximabUC, CD
                     AdalimumabUC, CD
Anti integrin
                    VedolizumabUC, CD
Anti IL 12/23 inhibitor
                    UstekinumabUC, CD


Up to 50% of CD patients, and 30% of UC patients may require surgery in their lifetime. Surgery to remove part of the bowel is recommended when the disease does not respond to medications, or if the disease results in complications such as narrowing, perforation, or cancer. 

In recent decades, risk of surgery has reduced as more effective medications are available and started at an earlier timing. As surgery does not cure the condition, patients will usually still need to be on long term maintenance medications. 


August 24, 2018

Hemorrhoids are swollen veins in the anus and lower rectum. Also called piles, the blood vessels become enlarged and swollen due to increased pressure within them caused by a number of factors. Cases of hemorrhoids in Singapore are very common as they will occur in adults from time to time.

Symptoms To Look Out For

Signs and symptoms of hemorrhoids can include:

  • Irritation and itching in your anal region
  • Bleeding during bowel movements – you may notice small amounts of bright, red blood in the toilet or when wiping on your toilet roll tissue
  • Discomfort, pain and swelling around your anus
  • A lump near your anus that may be sensitive or painful

When piles occur, they can also vary depending on the location.

External Hemorrhoids: They form under the skin external haemorrhoids be itchy or bleed.

Internal hemorrhoids: They develop and are located inside the rectum, where you usually can’t feel or see these hemorrhoids. Though they rarely cause discomfort, straining during passing stool can damage the hemorrhoid’s surface and cause it to bleed. Occasionally, an internal haemorrhoid can also be pushed through the anal opening through straining, also known as protruding or prolapsed haemorrhoid.

Thrombosed hemorrhoids: At times, a clot may be formed in an external haemorrhoid and can be extremely painful with swelling and inflammation. It can cause a hard lump near the anus which sometimes needs to be drained.

Causes Of Hemorrhoids

Under increased pressure, the veins around your anus will tend to stretch and swell up. Several common causes include

  • Chronic diarrhoea or constipation
  • Straining during bowel movements
  • Pregnancy
  • Obesity
  • Anal intercourse
  • Prolonged time spent sitting on the toilet

Prevention Of Hemorrhoids

The best way that can help in the prevention of hemorrhoids is to ensure your stools are kept soft, so they can pass easily without much straining. You can try these measures to reduce symptoms of hemorrhoids or prevent it from developing:

  • Drink plenty of water to help keep stools soft.
  • Don’t strain and hold your breath when trying to pass a stool, as it will create greater pressure in the veins in the rectum.
  • Don’t wait too long to pass a bowel movement. Go to the toilet as soon as you feel the urge, as your stool could become dry and it will be harder to pass by then.

Seeing A Doctor For Hemorrhoids

Piles are common, and bleeding during bowel movements is a typical sign of hemorrhoids. On the other hand, blood in the stool can also be caused by other diseases such as colorectal cancer or polyp.

You should at least visit a clinic for the family doctor to confirm that the bleeding is indeed from piles or haemorrhoid and not something more serious. The family doctor may refer you to a gastroenterologist. A specialist in gastroenterology will talk to you about the options available and the costs involved.
Your doctor should perform a digital rectal examination by using a gloved, lubricated finger into your rectum and visual inspection with a proctoscope in the clinic.

For a more complete examination, colonoscopy is needed. Colonoscopy is needed for the investigation of blood in stool, change in bowel habit, abdominal pain. Those with a family history of colorectal cancer should also undergo colonoscopy. It is also recommended for anyone with a positive stool occult test and all who are above the age of 45.

Treatment for piles can involve medications like ointments and creams, minimally invasive and surgical procedures performed by specialists such as rubber band ligation and hemorrhoid stapling. You can also manage the mild pain and swelling of piles with lifestyle and home remedies such as eating high-fiber foods, regular exercises, soaking in sitz baths, applying ice packs to relieve swelling and keeping the anal area clean daily.


August 17, 2018

The pancreas is an organ in the upper abdomen and is located behind the stomach, above the level of the belly button. It is located in close proximity to many important structures like the small intestine and important blood vessels and nerves. The pancreas performs two key functions: an endocrine function (makes insulin to regulate blood sugar levels) and exocrine function (produce digestive enzymes to help break down foods). 

In pancreatic cancers, cancer cells can develop from both types of cells with endocrine (hormonal) and exocrine (digestive) functions.

Pancreatic Cancer Symptoms

The incidence of pancreatic cancer in Singapore has increased over the years, and is one of the common cause of cancer deaths for both males and females.

Symptoms of pancreatic cancer may not appear until it has grown and developed further. Pancreatic cancer is also more frequently diagnosed in advanced stages as compared to early on in the course of the disease. Early first signs can be absent or quite subtle. Most pancreatic cancers are found after the cancer has grown or progressed, and it is highly lethal as it grows and spreads rapidly.

In advanced stages, symptoms of pancreatic cancer can occur such as:

  • Nausea and vomiting
  • Poor appetite and weight loss
  • Abdominal bloating
  • Back pain and abdominal pain
  • Pale/Greasy stools
  • Dark urine
  • Enlarged lymph nodes in the neck
  • Jaundice

Causes Of Pancreatic Cancer

No identifiable cause is found in most people who develop pancreatic cancer and it remains unclear. However, those with certain risk factors may have increased likelihood of developing pancreas cancer. These include:

  • Diabetes
  • Smoking
  • Family history (first-degree relatives with the disease or history of genetic syndromes associated with pancreatic cancer)
  • Obesity
  • Long term pancreatitis (inflammation of the pancreas)


Doctors can suggest steps for you to take to lower your risk of pancreatic cancer by making healthy lifestyle choices such as:

  • Lowering the fat in your dietary intake
  • Eating more fruits and vegetables
  • Reduce and stop smoking
  • Regular exercising and avoid too much weight gain
  • Limit alcohol use


Pancreatic cancer can be detected with CT scan or MRI. Ultrasound is not optimal to detect pancreatic cancer. Patient with suspected pancreatic cancer need to undergo at least a CT scan or MRI. In some cases, an endoscopic ultrasound examination may be necessary.

Pancreatic cancer, should be confirmed histologically when possible. A small piece of the cancer tissue is removed with a biopsy and put under the microscope for further examination. Special treatment of the tissue is often needed (staining).

Ca 19-9, a blood test, can be markedly raised in some pancreatic cancer but not all. It helps in diagnosis when it is markedly raised. 


Treatment for pancreatic cancer depends on the subtype of the cancer and based on its stage – how far it has spread in the body. Pancreas cancer in the early stage can be treated and is also possible of being curable with surgery. Further treatment after the surgery is often recommended and it involves chemotherapy or radiotherapy. Palliative treatment is focused on reducing the pain.

For patients diagnosed with advanced pancreatic cancer, surgery may not often be possible thus treatment with chemotherapy and/or radiotherapy are opted to shrink the cancer, reduce symptoms, and extend lifespan. The cost of pancreatic cancer treatment is typically covered by Medisave and most health insurance providers.

Cancer screening tests can be done at a specialist clinic. If detected early enough, cancers are treatable and even curable. However, cancer screening strategies to prevent pancreatic cancer death is not yet a reality. Sometimes, cancer marker is used for this purpose. Unfortunately, cancer marker often is not accurate. 

If someone without risk factors and symptoms were to have a raised ca19-9, more likely than not, he or she does not have pancreatic cancer. Doing ca19-9 to screen for pancreatic cancer creates a lot of anxiety for a lot of people without actually improving outcome most of the time.

If you happened to have elevated cancer marker, it does not mean that you definitely have cancer. You can speak to the specialist in gastroenterology who can then clarify your doubts and address your concerns.


August 3, 2018


Irritable bowel syndrome (IBS) is a common disorder that affects the gut. IBS affects approximately 10-20% of people worldwide, and can affect people of all ages and across both genders. The disorder can cause negative effects on one’s quality of life, affecting their lifestyle as well as bring about psychosocial impacts.

The physical symptoms of IBS are characterised by abdominal pain, frequent bloating, flatulence, constipation, abnormal bowel movements and changes in stool consistency. IBS is not life-threatening, however it requires long-term management to avoid triggering the symptoms caused by a number of factors like diet, poor sleep, lack of exercise and stress. 

Impacts Of IBS Beyond Health

If you have IBS, you may realise that you will begin to avoid certain social situations like attending a social gathering or going out for dinner. It is a risk to try out new types of food when you’re away from home as it may trigger your IBS symptoms and you will be in a rush to locate a restroom. When the symptoms are present, it may also create an unpleasant experience and make you develop a fear of social disapproval or embarrassment. The symptoms can also be uncomfortable and inconvenience for you to perform at work, affecting your concentration and focus.

The impact of IBS is also felt by spouses and partners. The quality of marital life can be negatively affected, whether from being able to participate in family outings or enjoy intimacy due to interference from IBS symptoms.

The Psychological Links To IBS

Increasingly, doctors are associating psychological disorders with people who have IBS in Singapore. Backed by scientific evidence and research endorsed by various institutes, studies have found evidence on the dysfunction along pathways running between the brain and intestines which are likely to contribute to the symptoms of IBS like constipation and abdominal pain. Nerves in the intestines which are experiencing excessive sensitivity can stimulate changes in the brain, while thoughts and feelings related to anxiety or depression can trigger exaggerated responses from the gut. However, it is not determined and known yet which comes first.

With a gastrointestinal condition deeply linked to your mental health, common psychiatric conditions diagnosed in IBS patients are depression, generalised anxiety disorder, dysthymia (long-term and chronic form of depression), and panic disorders. When they are suspected of having psychological issues, there is an option to see a psychologist and work hand in hand with gastroenterologists in Singapore. This process is believed to reduce psychological symptoms which in turn reduces bowel symptoms and improve their quality of life.

The Treatment & Management Approach To IBS

Medication is only part of the solution; treatment for IBS includes a holistic approach that is able to evaluate and address all the possible etiologies causing IBS. The causes are different for different individuals, and so the treatment would be different. These include:

  1. Assessing for any microbial imbalance such as Small Intestinal Bacterial Overgrowth (SIBO) by breath testing – this is available at gutCARE
  2. Assessing for dietary intolerances, such as intolerance to FODMAPs, which can also be done by breath testing
  3. Medication for symptom control – there are new medicines that can help
  4. Working out an overall biopsychosocial approach with our specialists, that would address the possible psychological effects as well

If you are easily stressed out or suffering from psychological issues with an added case of tummy troubles, contact gutCARE clinic and talk to our doctor regarding IBS. Our team of highly-trained gastroenterologists consists of specialists with a subspeciality interest in IBS who can carefully assess your condition before recommending any medication or treatment for IBS. Your medical history, current medication and symptoms will be reviewed.. Besides performing a physical exam, he may also order other tests such as blood test and stool test and possibly endoscopies to check for any other underlying health problems.

The treatment costs for IBS will vary depending on your health needs. You can also approach our staff who will be happy to assist you with further enquiries like payment methods and medical service costs.

Depending on factors like lifestyle and dietary, which varies from individual to individual, there will be a customised approach to identify and reduce those factors. This is aimed to improve the physical and mental health, resulting in lessened IBS pain. Book your appointment with gutCARE clinic for IBS today.


August 1, 2018

The definition of NAFLD requires that (a) there be the presence of fat within the liver cells (hepatic steatosis) either by radiological imaging or on histological examination of the liver through a liver biopsy and (b) no other identifiable causes of fat accumulation in the liver such as excessive alcohol comsumption, hepatitis C, medications or heriditary liver diorders.

NAFLD most commonly affects the middle-aged and elderly as risk factors such as obesity, hypertension, type II diabtests and hyperlipidaemia increase with age, however there is increasing prevalence of NAFLD being diagnosed in children and young adults who are overweight or obese. As obesity rates have risen in Singapore, the prevalence of NAFLD has also increased.

Although almost 40-50% of the population have NAFLD, only a small proportion of people will develop complications due to NAFLD.

NAFLD – Who Is At Risk Of Liver Disease Progression?

Patients with NAFLD can be divided into 2 groups. Those with either:

  • Simple Steatosis or Fatty Liver –There is fat deposition in the liver but with little or no inflammation and liver cell damage. It generally does not cause progressive liver disease or complications such as liver cirrhosis, liver failure of liver cancer. Patients with simple fatty liver make up the majority of patients.
  • Nonalcoholic steatohepatitis (NASH) – Occurs when fat deposition in the liver results in inflammation in the liver. If this inflammation in the liver continues over many decades, this may lead to scarring or fibrosis in the liver and eventually liver cirrhosis, liver failure and increases the risk of liver cancer. Steatohepatitis can be diagnosed through liver blood tests and a liver biopsy.

Symptoms of NAFLD


NAFLD is often a quietly progressive disease. Patients with NAFLD are often diagnosed incidentally when they visit a doctor and go for health screening. Often NAFLD is detected on ultrasound scan of the liver or NAFLD is suspected because of abnormal liver blood tests. NAFLD can have few or no symptoms in the early stages of disease. However, patients with advanced liver disease or cirrhosis or liver cancer may have symptoms including fatigue, jaundice, confusion, gastrointestinal bleeding, loss of weight, loss of appetite, abdominal bloating and distension and pain in the upper abdominal area.

Assessment of NAFLD

Patients with NAFLD and especially those with steatohepatitis or NASH should undergo further assessment by their doctor to exclude other causes of liver disease and have a baseline assessment of whether they already have progressive liver disease either by Fibroscan liver stiffness measurement or liver biopsy. They should also be screened for associated risk factors such as Type II diabetes, hypertension and hyperlipidaemia.

Management Of NAFLD

Currently the cornerstone of management for NAFLD is lifestyle modification and weight loss along with the treatment of associated metabolic risk factors such as Type II diabetes, hypertension and hyperlipidaemia.

  • In overweight/obese patients with NAFLD, a 7–10% weight loss is the target of most lifestyle interventions. Weight loss has been associated with a reduction in the fat within the liver and also an improvement in liver blood tests and liver histology.
  • Dietary recommendations should include total calorie reduction of 500-1000 Kcal/day and the exclusion of NAFLD-promoting components (processed food, and food and beverages high in added fructose).
  • Abstinence from alcohol
  • Regular exercise two to three times a week for 30 to 60 minutes to lose weight and reduce fat in the liver. Both aerobic exercise and resistance training have been shown to effectively reduce liver fat.

Patients with advanced liver disease such as liver cirrhosis should be followed up by a specialist to monitor for complications and for liver cancer screening and surveillance. Patients with NAFLD and advanced liver cirrhosis  or liver cancer may also be treated by liver transplantation.

Head down to gutCARE in Singapore and talk to one of our specialists today regarding any health concerns. Our gastroenterology clinicprovides sub-specialized care services for digestive and liver disorders. The cost of most investigations should be covered by majority of medical insurance providers. gutCARE also performs Fibroscan liver stiffness assessment, a state-of-the-art non-invasive tool used to provide a complete assessment of your liver health and check for progressive liver disease. Contact us to arrange for an appointment or speak to our friendly staff regarding any queries including cost of services.


August 1, 2018

Hepatitis B infection is a condition where a person was infected by Hepatitis B virus (HBV), this virus commonly affect the liver. It can lead to complications like liver cirrhosis(scarring), chronic hepatitis ( liver inflammation) and even liver cancer which can eventually lead to premature death after many years. 

In Singapore, estimated 3-4% population infected by hepatitis B virus, this is more commonly found in chinese population

How Is Hepatitis B Transmitted? 

The virus is transmitted by exposure to infectious blood or body fluids of someone who has chronic hepatitis B. it can be passed to someone else through unprotected sex, contaminated needles or other skin-piercing objects, direct contact of the blood or open sore. Hepatitis B most commonly transmitted between mother and newborn where the transmission rate is as high as 10% from mothers with high virus count to their new born, so it is compulsory for babies born to hepatitis B positive mothers to be vaccinated and given a special injection (with hepatitis B immune globulin) after birth. It is not spread by casual contact, sharing of eating utensils, coughing and sneezing, or breastfeeding.

What Are The Symptoms Of Hepatitis B?

Most patient with hepatitis B does not have symptoms. In some adult with acute hepatitis B, they can have symptoms of loss of appetite, persistent fatigue, vomiting, and jaundice.

Late symptoms of hepatitis B when the person has complications of cirrhosis are lower limbs swelling, abdominal swelling, jaundice and vomiting blood. They may have weight loss and abdominal pain if there is associated advanced liver cancer. Patient with advanced cirrhosis may also suffer from kidney failure, confusion or difficulty breathing.

How do i know if i have hepatitis B infection?

A simple blood test known as HBsAg(Hepatitis B surface antigen positive) can be done in any clinic or health screening centre. For those with chronic hepatitis B, the silent damage to the liver can occur for years until liver cirrhosis or liver cancer is discovered when it may then be too late.

Who should go for Hepatitis B screening?

All person with higher risk should get themselves tested. According to World Health Organisation, various groups of people who are identified to be at high risk of hepatitis B infection are those with:

  • Sexual and household contacts of people with hepatitis B infection
  • Injecting drug users
  • People who are exposed to or requires blood/blood products such as healthcare workers
  • Those with multiple sexual partners
  • Dialysis patients

Why early detection For Hepatitis B is important?

Early detection and regular screening can prevent complications of liver cirrhosis and liver cancer. Not all cases of hepatitis B need treatment.

Imaging of the liver is recommended to be done every 6 months to detect liver cancer early so this can be treated early. Remember early liver cancer can be cured with surgery or radiofrequency ablation(RFA).

Your specialist may also carry out test to assess the extent of fibrosis of the liver, typically using a fibroscan. It is non-invasive and provides valuable information to prognosticate your liver condition and the need for treatment. 

Controlling Hepatitis B Infection

In recent years, new drugs have become available for the treatment of hepatitis B which can help to control the virus and delay or possibly reverse liver damage. People infected with the virus should visit a clinic and see their doctors. Those who need treatment should see a liver specialist, even if they feel well or do not display any symptoms, so the infection can be controlled and prevent further complications.

In pregnancy, infected mothers should talk to their doctors about suitable treatments for hepatitis B to potentially reduce the risk of transmission to their baby during birth.


Treatment of hepatitis B is effective in preventing complications and further symptoms. It is usually carried out by specialists in gastroenterology. In Singapore, you can contact gutCARE to find out more. We would be happy to provide any information that you may need including cost of treatment.



This article is written by gutCARE liver specialist


August 1, 2018

The large intestine, or colon, is where the body extracts salt and water from solid wastes which is then moved through the rectum and expelled through the anus. Colon cancer is cancer of the large intestine – the final part of the digestive tract. Polyps, which are noncancerous (benign) lumps, may form on the inner wall of the colon and rectum but they may also develop into cancer over time. One of the most common cancers in Singapore is colon cancer which affects both men and women.  

Screening For Colorectal Cancer

Colon cancer is one of the few cancer that is actually preventable. Prevention of colon cancer is done through screening.

All person above the age of 45 should go for colorectal cancer screening regardless of whether they have symptoms. The previous recommendation used to be for those above the age of 50 and it is recently updated by the American Cancer Society.

In Singapore, colorectal screening with stool test is available through polyclinics, family doctors and various organization such as Singapore Cancer Society. This should be done at least yearly

Alternative to stool test is to do colonoscopy once every ten years. 

All persons with increased risk should undergo colonoscopy even earlier. These include people with

  • A strong family history of colorectal cancer or certain types of polyps
  • A personal history of colorectal cancer or certain types of polyps
  • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
  • A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or Lynch syndrome (also known as hereditary non-polyposis colon cancer or HNPCC)
  • A personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer

During colonoscopy, polyps are detected and remove. The procedure to remove the polyp is called polypectomy. The polyps will be retrieved for examination under the microscope. 

Effective removal of all polyps during colonoscopy will prevent colorectal cancer.


Most colorectal cancers begin as a benign polyp. Polyps, usually do not give rise to any symptoms unless they are very large.

Many people with colon cancer experience vague or no symptoms  in the early stages. When they do appear at a later stages, they can also vary depending on the cancer’s size and location.

 The common symptoms  of colorectal cancer include:

  • Blood in stool or rectal bleeding
  • Change in bowel habits, including constipation, diarrhea, or a change in stool consistence which lasts longer than 4 weeks
  • Weakness or fatigue
  • Persistent abdominal symptoms like gas, cramps and pain
  • Unexplained weight loss

 Causes And Risk Factors

In most cases, the exact causes of colon cancer are unknown, but it has several potential risk factors which are:

  • Age:A great majority of people diagnosed with colon cancer are aged 45 years and above, thus have an increased risk of the disease.
  • Personal History:If you already have been detected with polyps or diagnosed with colon cancer in the past, you are at a higher risk of colon cancer.
  • Intestinal Conditions:People with chronic inflammatory diseases of the colon such as Crohn’s disease and ulcerative colitis face a significant increased risk of colon cancer.
  • Family History of Colon Cancer: Individuals with genetic syndromes passed through family generations as well as those who have relatives or family members with polyps or colorectal cancer are also at higher risk of colon cancer.
  • Obesity and Sedentary Lifestyle: These factors are interrelated and can increase the risk of colon cancer.
  • Dietary Habits:These include preserved meat, red meat and smoking.


Treatment of colon cancers, largely depend on the stage of cancer. Surgery, chemotherapy and radiation therapy may be recommended as treatment options. 

Visit a clinic or talk to a specialist in gastroenterology about your options and the costs involved, and discuss which tests or treatment methods are more appropriate for your needs.


June 25, 2018

GERD (Gastro Esophageal Reflux Disease) is a digestive disorder where the stomach contents flow back upwards or ‘reflux’ back into the esophagus, which is the passage that connects the mouth to the stomach. Normally, there is a muscle that holds the junction between the esophagus and stomach known as the lower esophageal sphincter (LES). This muscle acts a one-way valve which allows food to enter the stomach from the esophagus, but prevents stomach contents from flowing back up. 

Causes Of GERD

GERD occurs in people where the LES muscle is weak or relaxes inappropriately. The severity of GERD depends on the dysfunction of the LES as well as the amount of fluid brought up from the stomach. It is believed by some doctors that a hiatal hernia can affect and weaken the LES thus increasing the risk for GERD. This happens when the upper part of the stomach protrudes or pushes through the esophageal hiatus into the chest.

Sudden physical exertion or even coughing, straining, vomiting can cause increased pressure in the abdomen which results in hiatal hernia. Pregnancy and obesity can also contribute to this condition. Many people over the age of 50 have a small hiatal hernia, however it can still affect people of all ages.

Lifestyle and dietary choices can also play a role in GERD. Certain foods and beverages such as coffee, fried or fatty foods, spicy foods and chocolate may trigger reflux and heartburn. Cigarette smoking can also be a factor as studies show it relaxes the LES.

Symptoms Of GERD

Heartburn is also a common symptom of GERD, where a burning chest pain sensation can be felt as it moves upward to the neck and throat. It also feels like food is coming back into the mouth, leaving an acid or bitter taste. The bitter taste in the mouth is actually the taste of stomach acid. You can also experience breathing problems, nausea, vomiting, difficulty in swallowing and the feeling of having a lump at the back of your throat.

Pregnancy is also a well-known risk factor for GERD. It is typically mild and does not cause damage to the inner lining of the esophagus. The symptoms also tend to resolve after pregnancy on its own without the need for treatment, and there are no long-term implications.

You can try some quick and simple homecare measures to alleviate your symptoms such as:

  • Elevating your upper body – If you are sitting or lying down, having an upright posture will put less pressure on your LES and prevent stomach acid from rising into your esophagus.
  • Wearing loose clothing – Tight clothing can be compressing your stomach and easily cause heartburn to occur
  • Finding remedies in the kitchen – Try ginger in soups or tea to soothe your heartburn condition. You can steep dried ginger root, raw ginger root, or ginger tea bags in boiling water to make ginger tea. Baking soda can also help to calm heartburn episodes by neutralising the stomach acid. In a glass of water, dissolve a teaspoon of it and drink it slowly.

For pregnant patients who continue to have symptoms despite these lifestyle measures, over the counter medications available in Singapore such as antacids may provide quick relief. Avoid antacids containing sodium, as these can lead to excess fluid retention in pregnancy.

Management & Treatment For GERD

Lifestyle and dietary changes are recommended for people seeking treatment for GERD. It can help to decrease the amount of reflux and reduce damage to the lining of the esophagus. Avoiding foods and beverages such as citrus fruits and juices, fatty foods, chocolate, tomato products, spicy foods, and alcoholic beverages as they can either weaken the LES or irritate a damaged esophageal lining.

To manage GERD, try eating smaller portion during mealtime and avoid eating 3 hours before bedtime to allow the acid in the stomach to decrease and reduce the chances of reflux. In addition to dietary and lifestyle changes, antacids and medication treatments may be prescribed. For chronic reflex and heartburn, medications such as H2 blockers  are recommended to reduce acid in the stomach. Another type of drug is the proton pump inhibitor which inhibits an enzyme necessary for acid secretion. Talk to your doctor about the medication options available and their costs. If the symptoms of GERD persist and are not relieved by the mentioned treatments, patients may need a more complete diagnostic evaluation through a variety of tests and procedures conducted by a specialist.

If you suffer from persistent GERD, you should visit a clinic and consult with specialist for further evaluation.  You may require specific medication or procedures for proper treatment. Your doctor will ask about your symptoms, medical history and any taken medications before performing a physical exam or lab work to test for underlying conditions. When GERD is suspected, the main diagnosis tests carried out include 24 hour pH monitoring and gastroscopy available in gutCARE.


June 24, 2018


The symptoms of bleeding of the digestive tract include blood in stool, black stool, and vomiting blood. You should see your doctor for a proper evaluation if you have bleeding of the digestive tract, even if you feel alright. Quite often, a referral to a gastroenterologist is needed.


There are many causes of bleeding of the digestive tract. It can be divided generally into bleeding from the upper digestive tract and from the lower digestive tract. Bleeding from the upper digestive tract cause black stool. The person may also vomit fresh blood (this is called hemetemesis). Bleeding from the lower digestive tract will manifest as fresh blood from the anus. Sometimes this is mixed with stool.

Bleeding of the upper digestive tract can be a result of diseases such as:

  • Stomach and duodenum ulcer
  • Abnormal, enlarge vessel in the esophagus or stomach due to liver hardening (called varices)
  • Reflux esophagitis
  • Tear of the esophagus from severe retching and vomiting
  • Abnormal blood vessels in the stomach
  • Cancer of the esophagus or stomach
  • Bleeding from the bile ducts

Bleeding of the lower digestive tract can be a result of diseases such as:

  • Piles or hemorrhoids
  • Cancer of the colon
  • Large colonic polyps
  • Diverticulosis
  • Abnormal blood vessels of the colon
  • Inflammation of the colon from infection or inflammatory bowel disease

What to do if you have severe bleeding digestive tract?

Severe bleeding will result in low blood pressure and the person will experience giddiness. The heart rate will also go up and the person may feel that his or her heart is beating very quickly.

If you have severe bleeding of the digestive tract, you should head immediately to the emergency department of the hospital. Call an ambulance if necessary.

Going to the clinic will generally not be helpful because there is very little that the doctor can do at the clinic.

Do not eat anything because the endoscopy examination requires fasting for about 6 hours.

Be prepared to stay at the hospital for about 1-3 days, depending on the severity of the bleed.


June 24, 2018

Gallstone Disease

Gallstones are common. They are caused by crystallization of bile salt and other minerals in the bile.

Most gallstone does not give rise to any symptoms. They should be left alone.

Some gallbladders do not function properly and as a result, the stone may get stuck for a few hours at the neck of the gallbladder after a heavy meal. This results in a pain that is felt in the upper abdomen which can last anything from one to six hours. The pain is usually severe. It can go to the back. Occasionally the pain is accompanied by nausea and vomiting. This symptom is known as biliary colic.

Biliary colic precedes serious complications of gallstones such as cholangitis (infection of the bile ducts), cholecystitis (inflammation of the gallbladder) and pancreatitis (inflammation of the pancreas). Once there is biliary colic, one should seriously consider surgery to remove the gallbladder to prevent these serious complications.

Jaundice and Bile Duct Obstruction

Any obstruction of the bile duct would result in jaundice (yellowing of the skin and the white of the eyes).

Jaundice that is caused by a stone in the bile duct (cholangitis), is usually accompanied by signs of infection such as fever. If the obstruction occurs acutely, there may be a significant amount of pain.

Jaundice that occurs slowly may not cause pain. One of the causes of painless obstructive jaundice is cancer of the head of the pancreas.

Besides obstruction of bile duct, jaundice can occur in liver diseases and hemolysis (where red blood cells have shortened lifespan).

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