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August 24, 2018

During digestion, food passes from the stomach to the small intestine where breakdown by enzymes and ultimately absorption takes place. Unabsorbed food then passes into the colon, where bacteria in the colon break it down into waste products. This process of bacterial fermentation in the colon produces gas, which is released through the anus as flatus. Carbohydrates such as sugars produce the most gas as they ferment easily, while fibre is indigestible but helps to regularize your bowel movements and keep the digestive system healthy. This natural process occurs daily in all people, and the average person passes flatus 8-20 times per day.

Flatus comprises mainly of carbon dioxide and other non-smelling gases like oxygen, nitrogen and hydrogen. The foul smell comes from sulphur compounds, which makes up <1% of the gas. Many red meats and protein contain high amounts of sulphur, so eating such foods may result in a more foul smelling flatus. This can also be caused by certain medical conditions like internal intestinal bleeding and intestinal infections.

Passing wind or flatulence is a natural bodily function. Occasionally excessive flatulence occurs when there is too much stomach and intestinal gas released from the anus. Most common causes of excessive flatulence are lactose intolerance. Sometimes the patient may have fructose intolerance or small intestine bacteria overgrowth.

Excessive flatus is commonly related to:

  • Constipation, as the longer food waste remains in the colon, the more time it has to ferment.
  • An underlying digestive disorder which affects the digestion and absorption of food components and causes them to present in excessive amounts for fermentation. This includes lactose intolerance and celiac disease (which causes gluten intolerance).
  • Eating and drinking too quickly without pacing yourself results in more gas entering the intestines.
  • Too much bacteria in the small intestine, which produces gas in addition to the gas produced in the colon
  • Eating gassy foods or drinking carbonated drinks
  • Stress or anxiety.

If these measures do not work, please visit a clinic in Singapore and see a doctor for flatulence. There are many new and effective medications with various costs that can help improve these symptoms accompanying flatulence.

Hydrogen-methane breath test can also be carried out by our specialist in Singapore for sugar intolerance and bacterial overgrowth, which can help patients to address the underlying cause of excessive gas. Effective treatment is then recommended. Our doctor will evaluate your symptoms, medical history and risk factors to narrow down the possible causes of your flatulence problem. Aside from a physical exam, he may also run tests such as CT scan, endoscopy, blood test and breath test to determine the condition of your digestive tract.


August 17, 2018

Gastric pain is a term often used to describe a pain in the middle of upper abdomen. Sometimes it is simply referred to as “gastric” by people in Singapore. The word “gastric” means “of the stomach”. The stomach is a digestive organ located in the upper abdomen that follows the esophagus. It is responsible for mixing food before further digestion. While most of the pain in the middle of the upper abdomen is indeed from problem arising from the stomach, some of the pain may originate from other organs such as gallbladder, bile duct, pancreas, small intestine (duodenum) or even the liver. “Epigastric pain” is a more accurate term that healthcare professions use to describe the pain in the middle of the upper abdomen.

Causes Of Epigastric Pain

There are many causes of epigastric pain. The different causes of epigastric pain has different characteristics.

Pain caused by stomach or duodenal ulcer usually last for weeks. It comes on and off and often is worse when you are hungry. Some may get relieve with food. The pain tends to be mild to moderate in severity and does not have a clear time of onset. It usually does not wake a person from sleep. Occasionally the pain may also be felt at the back at the same time. Pain similar to stomach ulcer sometimes can be caused by medication such as pain killers or even just drinking too much alcohol.

Pain caused by gallstone is quite different. Sometimes this pain can be felt more to the right side of the upper abdomen. The pain has a clear time of onset: meaning the person usually can tell you quite clearly that the pain started at a particular time. The pain can last anywhere from one to six hours, after which the pain will subside. It is usually more severe compared with the pain caused by stomach ulcer. This pain often happens in the middle of the night where a person wakes up with pain and goes back to sleep a few hours later when the pain subsides. Sometimes, the pain may be accompanied by vomiting and heavy sweating. Usually the person is well before the onset of pain and on the next day. This pain is termed “biliary colic” and it is caused by gallstone that is temporarily stuck at the neck of the gallbladder.

Pain caused by pancreas inflammation (pancreatitis) is very severe. Usually the person will bend over in pain and prefers to lie still. The pain goes to the back. 

Pain caused by cancer often may not be severe. The main characteristic of the pain is its persistence over weeks. These pain are usually worse at night when there is nothing to distract us. Other symptoms that may suggest the diagnosis of cancer such as weight loss, difficulty swallowing, change of bowel habit, blood in stool or black stool may or may not be present.

One of the questions that the doctor often ask is whether your stool is black. The reason why this is asked is that when bleeding occurs in the stomach, the blood would be digested and passed out as a black, sticky stool that almost looks like tar. This stool as a very peculiar fishy smell. If your stool is dark brown (and not truly black and sticky) the answer to the question: “Do you have black stool?” is “No, my stool is dark brown”. Black in this context is as black as tar. 

Severe sudden abdominal pain that is worse with movement and with pressing the abdomen is termed “surgical abdomen”. It means that something serious that may need immediate surgery may have happened. One should seek help at the hospital emergency immediately. If you are not sure: visit your neighbourhood family clinic. The general practitioner are trained to detect a “surgical abdomen” and send the appropriate cases to the emergency department.

Sometimes the cause of the epigastric pain is not apparent. All the investigations may be normal. Some of these pain may be related to stress and some of it may be related to abnormal motility and function of the stomach. Some other rare diseases may have similar pain as well.

In actual fact, determining the cause of the pain may not be a simple process. It often takes an experience specialist to do the detective work. Various investigation may be necessary to help arrive at the most probable diagnosis. 

When To Seek Specialist Care

Epigastric pain that persist after simple treatment by your family doctor usually needs further investigations.

This is especially true for those older than 35 years of age and those with alarm symptoms such as recurrent vomiting, loss of weight, loss of appetite, black stool, difficulty swallowing and change in bowel habit. 

Those with family history of stomach cancer and pancreatic cancer should also be investigated earlier. 

Investigations For Epigastric Pain

Common investigation would be a gastroscopy or upper gastrointestinal tract endoscopy. Ultrasound of the hepatobiliary system would be useful for the biliary type of pain. CT scan is useful as well to detect the presence of cancer of the pancreas. Rarely, MRI or endoscopic ultrasound may be needed.

Who Does The Investigations

The specialist doctor of the digestive tract would be the most appropriate doctor to do so. The name of the specialty is called gastroenterology and the specialist is a gastroenterologist.  

Cost Of Healthcare And How To Choose

In Singapore, a good proportion of the cost of investigation are covered with medisave deduction regardless of whether you go to a government or private hospital. 

Private health insurance and many company health insurance actually do cover the entire cost of investigations in most cases even in private hospital or specialist clinics. Many people are not aware of the healthcare benefit offered by their own company: you should check yours.

The charges of the various private hospitals and clinics are also not the same. You should do some homework to compare prices before deciding.

Different private doctors also charges different fees for the same procedure depending on their level of experience and the demand for their services. You can and should check their fees against the published “Total Operation Fees” from the ministry of health web page. Financial counselling is always done prior to any surgical procedure.


August 17, 2018


What is Difficulty Swallowing (Dysphagia)?

Difficulty swallowing is also called dysphagia. It is usually a sign of a problem with your throat or esophagus -the muscular tube that moves food and liquids from the back of your mouth to your stomach. Although dysphagia can happen to anyone, it is most common in older adults, babies, and people who have problems of the brain or nervous system.

There are many different problems that can prevent the throat or esophagus from working properly. Some of these are minor, and others are more serious. If you have a hard time swallowing once or twice, you probably do not have a medical problem. But if you have trouble swallowing on a regular basis, you may have a more serious problem that needs treatment.


What Causes Dysphagia?

Normally, the muscles in your throat and esophagus squeeze, or contract, to move food and liquids from your mouth to your stomach without problems. Sometimes, though, food and liquids have trouble getting to your stomach. There are two types of problems that can make it hard for food and liquids to travel down your esophagus:

The muscles and nerves that help move food through the throat and esophagus are not working right. This can happen if you have:

– Had a stroke or a brain or spinal cord injury.

– Certain problems with your nervous system, such as post-polio syndrome, multiple sclerosis, muscular dystrophy, or Parkinson’s disease.

– An immune system problem that causes swelling (or inflammation) and weakness, such as polymyositis or dermatomyositis.

– Esophageal spasm: This means that the muscles of the esophagus suddenly squeeze. Sometimes this can prevent food from reaching the stomach.

– Scleroderma:  In this condition, tissues of the esophagus become hard and narrow. Scleroderma can also make the lower esophageal muscle weak, which may cause food and stomach acid to come back up into your throat and mouth.

Something is blocking your throat or esophagus. This may happen if you have:

– Gastroesophageal reflux disease (GERD). When stomach acid backs up regularly into your esophagus, it can cause ulcers in the esophagus, which can then cause scars to form. These scars can make your esophagus narrower.

– Esophagitis. This is inflammation of the esophagus. This can be caused by different problems, such as GERD or having an infection or getting a pill stuck in the esophagus. It can also be caused by an allergic reaction to food or things in the air.

– Diverticula. These are small sacs in the walls of the esophagus or the throat.

– Esophageal tumors. These growths in the esophagus may be cancerous or not cancerous.

– Masses outside the esophagus, such as lymph nodes, tumors, or bone spurs on the vertebrae that press on your esophagus.

– A dry mouth can make dysphagia worse. This is because you may not have enough saliva to help move food out of your mouth and through your esophagus. A dry mouth can be caused by medicines or another health problem.

What are the Symptoms?

Dysphagia can come and go, be mild or severe, or get worse over time. If you have dysphagia, you may:

– Have problems getting food or liquids to go down on the first try.

– Gag, choke, or cough when you swallow.

– Have food or liquids come back up through your throat, mouth, or nose after you swallow.

– Feel like foods or liquids are stuck in some part of your throat or chest.

– Have pain when you swallow.

– Have pain or pressure in your chest or have heartburn.

– Lose weight because you are not getting enough food or liquid.

How is Dysphagia Evaluated?

If you are having difficulty swallowing, your doctor will ask questions about your symptoms and examine you. He or she will want to know if you have trouble swallowing solids, liquids, or both. He or she will also want to know where you think foods or liquids are getting stuck, whether and for how long you have had heartburn, and how long you have had difficulty swallowing. He or she may also check your reflexes, muscle strength, and speech.

To help find the cause of your dysphagia, you may need one or more tests, including:

– X-rays: These provide pictures of your neck or chest.

– A barium swallow: This is an X-ray of the throat and esophagus. Before the X-ray, you will drink a chalky liquid called barium. Barium coats the inside of your esophagus so that it shows up better on an X-ray.

– Fluoroscopy:  This test uses a type of barium swallow that allows your swallowing to be videotaped.

– Laryngoscopy:  This test looks at the back of your throat, using either a mirror or a fiber-optic scope.

– Esophagoscopy or upper gastrointestinal endoscopy:  During these tests, a thin, flexible instrument called a scope is placed in your mouth and down your throat to look at your esophagus and perhaps your stomach and upper intestines. Sometimes a small piece of tissue is removed for a biopsy. A biopsy is a test that checks for inflammation or cancer cells.

– Manometry:  During this test, a small tube is placed down your esophagus. The tube is attached to a computer that measures the pressure in your esophagus as you swallow.

– pH monitoring, which tests how often acid from the stomach gets into the esophagus and how long it stays there.


August 17, 2018

Rectal bleeding, or blood in stools, refers to any blood that is passed out of the anus.Some cases would just have blood stain on toilet paper when wiping. It can be quite distressing to see the entire toilet  bowl covered with fresh blood for the more severe cases. Some bleeding occurs without being accompanied by stool, other times the blood is mixed with stool. Most of the time bleeding is not life threatening but occasionally it may be so severe that it can cause low blood pressure and giddiness.

The color of the blood may be indicative of where the bleeding occurs. Fresh blood tends to come from the area nearer to the anus. Bleed from deeper part of the colon would appear darker. Bleeding that arises from the stomach would cause stool that is completely black. It appears like tar and has a distinctive fishy smell. 

Sometime the amount of blood in stool is too little such that it cannot be seen with a naked eye. Stool test may reveal the presence of blood in these cases. In Singapore, the kit to test for blood in stool are distributed freely for eligible Singaporean by organization such as Singapore Cancer Society.

Causes Of Blood In Stool

 The most common cause of blood in stool is haemorrhoid or piles. It results from swelling of blood vessels near the anus. There may or may not be a lump at the anus. The blood tends to be bright red. The amount of bleeding varies. Other symptoms of piles includes itch, pain and mucus discharge.

If the bleeding is associated with severe pain in the anus, the most likely cause is anal fissure. It usually occurs after passing very hard stool and feels like “passing a knife” through the anus.

Cancer of the colon can also cause bleeding. Sometimes, blood in stool may be the only symptom of colon cancer. Other symptoms of colon cancer occurs in the later stages are: abdominal pain, change in bowel habit, weight loss and shortness of breath (from lack of blood)

Polyps of the colon are likely precursor to cancer itself. Most of the time it does not give rise to any symptoms but sometimes it can cause bleeding. 

Blood  in stool can also occurs with inflammation of the colon. This can occurs when someone gets a severe bacterial infection causing diarrhoea with blood and fever, often called dysentery. Another condition that occurs with diarrhoea with blood and fever is inflammatory bowel disease.

Assessment Of Blood In Stool

You should visit a clinic if you have blood in your stool. The doctor will determine your risk of having a more serious cause other than piles after talking to you and conducting a rectal examination. If he feels that your bleeding is not from a simple piles, he will refer you to see a gastroenterologist, a specialist that helps to manage gut symptoms. You should never ignore the blood in your stool.

The gastroenterologist would likely carry out colonoscopy to determine the exact cause of the bleeding.

If your stool have blood on stool testing, you will likely also need colonoscopy.

Cost Of Colonoscopy

A good proportion of the cost of the colonoscopy is covered with Medisave deduction in Singapore. It is also fully covered in most cases of private health insurance and company health insurance.

Treatment And Management

Treatment of blood in stool depends on the causes.

Bleeding from piles are often self-limiting. it will also often response to simple medication available from family doctors. Sitz bath can be helpful at times. Sometimes piles or haemorrhoid ligation can be done to treat it. The more sever cases may need surgery.

Bleeding from anal tear involve medication that is applied on the anus. Stool softening often would help.

Bleeding from the more serious causes would need proper treatment of the underlying cause.


August 17, 2018

Vomiting is the forcible voluntary or involuntary emptying of the contents in the stomach through the mouth. It is colloquially known as throwing up, puking, and retching. It can be a one-time event when something doesn’t settle right in the stomach or occur recurrently which may be caused by underlying medical conditions. 

Typically, one with nausea will experience the uneasiness sensation that vomiting might occur. Other signs include gagging, involuntary stomach reflexes, the need to bend over, and the mouth filling with saliva (in order to protect the teeth from stomach acid).

What Causes Nausea Or Vomiting?

Obvious Causes

Sometimes the causes of nausea or vomiting are obvious. 

Chemotherapy, for instance, is well known to be able to cause nausea and vomiting. There are many medications that can cause nausea and vomiting. Reading the drug insert (the piece of paper that comes with the packaging) would give you the information. Many people that have trouble swallowing tablets would tell you that they vomit while attempting to take any tablet. 

When a women of reproductive age has nausea and vomiting, the obvious question to ask is: is she pregnant?

Food poisoning and gastroenteritis is also easy to diagnose: Food poisoning occurs shortly after eating contaminated food. Before long, all those who ate the same food would have abdominal pain and vomiting and various amount of diarrhoea. Gastroenteritis refers to infection of the gut by a bacterial or a virus that causes abdominal pain, vomiting, fever and diarrhoea.

Some nausea and vomiting are normal reaction to something disgusting and distressing. This is easy to recognize and do not indicate any underlying disease. 

Motion sickness is another common cause of nausea and vomiting.

If you drink too much alcohol, you will vomit. If you eat too much, you will also feel like vomiting. Again, everyone knows that.

Not So Obvious Causes

It takes detective’s mind to find the cause of nausea and vomiting at times. In these instances, you will need an experienced doctor to help.

The clues can often be found in the accompanying symptoms: 

If the nausea and vomiting is accompanied by a headache, this will point towards a problem in the brain, be it migraine, a brain tumour or other problem that cause a rise in pressure in the skull.

Those associated with severe giddiness can be caused by an ear, a brain or cervical spine problem.

If you have concomitant eye pain or blurring of vision, the nausea is most likely caused by problems in the eye. 

Those with severe pain from any causes will have nausea and vomiting. Any form of severe infection can also cause nausea and vomiting. It is very common to have nausea and vomiting from urinary tract infection in the elderly, for instance.

What If There Is No Other Symptoms?

Vomiting after every single meal points towards obstruction of the digestive system. Obstruction, even if partial, would also result in weight lost over time. A common cause of obstruction of the digestive system is cancer. Investigation is important.

Gastroparesis, a condition where the movement of the stomach is impaired, would also cause vomiting after almost every meal as well. Commonly this occurs in diabetes patient.

Cyclic vomiting syndrome is the condition where a person suffer from recurrent episodes of severe vomiting. Each episode can last a few hours to a few days. Vomiting can be as many as 20 times an hour. Most of the episodes are very similar to other episodes. The person suffering from this condition often goes without a correct diagnosis for many years.

When Should You Seek Specialist Help?

You should seek specialist help when your symptoms persist more than a week and the cause of the symptoms is not obvious. The specialist of the digestive tract is called gastroenterologist. 

What Are The Investigations For Nausea And Vomiting?

It depends on the possible causes after the assessment. Some of the more common investigations are gastroscopy, barium study, barium meal and CT scan of the abdomen and MRI of the brain.


August 17, 2018

Diarrhoea is defined as a loose or watery stool and stool frequency of more than 3 times a day. It is one of the most common conditions seen by GPs in Singapore. There are two types of diarrhoea – acute and chronic, which can be quite different in terms of investigation and management. Acute diarrhoea is more prevalent than chronic diarrhoea, affecting 15 to 25 percent of the population annually as compared to the latter at 5 percent.

While acute diarrhoea is almost always due to foodborne and bacterial infections, there are many causes of chronic diarrhoea including irritable bowel syndrome (IBS) and food intolerance. Other serious underlying health conditions may also be the cause such as thyroid disease, digestive cancers, chronic pancreatitis and inflammatory bowel disease.

Diagnosing Acute VS Chronic Diarrhoea

The first priority is to determine whether the patient is suffering from acute (which lasts for 2 weeks or earlier) or chronic or persistent diarrhoea (with a duration of more than 4 weeks).

In acute diarrhoea, the patient is checked for the severity of illness, fever and blood in stool, and travel history. Doctors may start the treatment for diarrhoea without any investigations, but based on clinical history. Stool microbiological assessment may be considered for varying acute diarrhoea conditions like prolonged watery diarrhoea that occurs for more than a week, followed by an antibiotic treatment.

It is important in chronic diarrhoea to differentiate between functional and organic diarrhoea. Most chronic diarrhoea requires specialist referral for further investigations involving endoscopy and imaging especially those with a family history of digestive cancer, diarrhoea that affects quality of life, diarrhoea that occurs even while asleep, oily or pale stool, blood in stool and having blood in the stool.

Most cases of chronic diarrhoea should be referred to a gastroenterology specialist to determine the underlying conditions for further management except cases that responded easily to lifestyle and diet modification, such as low FODMAP diet and gluten-restricted diets, alongside fiber supplements, probiotics, and anti-diarrhoeal medication. In the majority of the cases, up to 70 percent of patients with initial diagnosed functional diarrhoea report that basic medication does not control their diarrhoea symptoms adequately. Differentiating functional diarrhoea from a more serious organic cause may not be easy in these cases.

The key aim of alleviating symptoms of acute diarrhoea is to prevent dehydration and the imbalance of electrolyte. In order to optimize fluid and salt intake, patients will be advised to consume sufficient water, sports drinks, juices, saltine crackers and even oral rehydration salts for moderate-to-severe cases. GPs can also provide charcoal tablets and probiotics, as antibiotics should only be considered for cases like dysenteric diarrhoea, severe watery diarrhoea with fever and travel-associated diarrhoea.


If you are suffering from chronic diarrhoea and simple measures mentioned above have failed to control the symptoms, talk to our specialists at gutCARE in Singapore. Our team of highly experienced doctors will be able to work with you to determine the cause of your symptoms and give you relief. Some Investigations that we carry out for chronic diarrhoea include hydrogen-methane breath tests, colonoscopy with colon biopsy, Imaging studies for pancreas, stool tests and blood test.

Aside from prescription medication or over-the-counter drugs, the symptoms of diarrhoea can be managed with measures like replacing fluid losses to avoid dehydration, reducing certain food intake to avoid aggravating the diarrhoea and eating low-fiber foods.

At gutCARE, we can help you. You can also approach any of our friendly staff to inquire about how our clinic can help and also the costs involved.


August 17, 2018

What Is Heartburn? 

Heartburn occurs when acid or other stomach contents “back up” or “reflux” into the esophagus, which connects the throat to the stomach and where food passes through from the mouth. Also called acid indigestion, heartburn is a symptom of gastroesophageal reflux (GERD).

The issue stems from the lower esophageal sphincter (LES), a muscle that is located between your stomach and esophagus. When it’s functioning well, it will open to let food into your stomach or to let you blech and close again. But if it is weak or relaxes at inappropriate times and doesn’t close tightly or quickly enough, it will cause acid backwash which results in heartburn. It can be described as a burning discomfort in the upper belly or below your breastbone.

Heartburns is a common symptom. It is often caused by overeating or there is too much pressure on your stomach due to constipation, obesity or pregnancy. Consuming spicy food or taking alcohol can also relax your LES too much or increase stomach acid.

What Does Heartburn Means?

Heartburn usually means you have gastroesophageal reflux disease (GERD)

Other accompanying symptoms to GERD include bitter taste in the mouth, burning at the back of your throat, difficulty swallowing, chest pain after lying down, bending over or eating, chronic cough and persistent sore throat or hoarseness.

What Causes Heartburn?

The risk of heartburn is increased when there is a greater production of acid in the stomach caused by the foods we eat and drink such as acidic juices (orange, grapefruit, pineapples), acidic foods (tomatoes), caffeine, alcohol, chocolate and carbonated beverages. Over-the-counter medications also may precipitate heartburn.

Other factors include smoking and consumption of high-fat content or spicy foods, pregnancy, and obesity.

Relieving Heartburn

If you suffer from the occasional heartburn, you may find relief with over-the-counter such as antacid. Your doctor may prescribe proton pump inhibitor or other medication to lower the acid in your stomach. They help to heal the esophageal lining. Other quick remedies include mixing baking soda with water, making ginger tea, taking licorice supplements, wearing loose clothing, and elevating your body during bedtime.

Seeing A Doctor For Heartburn

If you are reaching for antacids or medication more often than not, and you are not getting better, it’s time to seek medical help and head to a clinic. You may need additional investigation if occurs more than once a week for six months or longer.

Long-term heartburn or GERD can lead to serious problems such as narrowing or scarring of the esophagus and eventually cancer of the esophagus.

Share with your doctor or see a specialist in gastroenterology regarding your symptoms. He may begin with a history and physical examination to make a diagnosis of GERD and recommend treatment. He may carry out several tests needed to evaluate the underlying issue, and gastroscopy is often carried out for further evaluation. For refractory cases, specialized study such as 24-hour pH study may be carry out. In Singapore, this is available at gutCARE or major Government hospital.

Lifestyle modification and dietary changes can also help in managing heartburn. A modest weight loss can have significant benefit in term of symptom improvement. Avoid eating heavily or eating within two hours of bedtime, or lying down soon after a meal. Cut down or stop eating certain known foods like fatty, fried and acidic foods, citrus juices and alcohol. As everyone reacts somewhat differently to specific foods, keep a food journal to keep track of what you eat, what time, any activity that worsened the condition and how long is the duration. This way, you can correlate the offending foods with heartburn incidents.

Cost of investigation and treatment in Singapore is often fully covered by private health insurance or company health insurance. You can contact us to find out more.


August 16, 2018

Abdominal pain is the pain felt in the area between the chest and pelvis. Pain can arise from the tissues of the abdominal wall, or originate from organs of the abdomen including the stomach, liver, pancreas, colon, gallbladder and small intestine.  

There are different types of abdominal pain: The pain that is felt in the center of the upper abdomen is called epigastric pain (some refer to this as “gastric”). The pain that is felt around the umbilicus is called paraumbilical pain. The pain that is felt in the center lower abdomen is called suprapubic pain.

Sometimes people call it stomach pain. Strictly, the stomach is an organ in the abdomen and the disease of the stomach normally give rise to pain in the upper abdomen, which is an epigastric pain.

Belly pain is another non-specific term that often used interchangeably with abdominal pain.

Abdominal pain is one of the common health complaints in Singapore. The abdomen is home to many vital organs, muscles, connective tissues and blood vessels that may be affected, hence there are many various contributing causes to abdominal pain. While most cases of abdominal pain are mild and can be easily treated, it can also be a sign of a serious illness.

Causes Of Abdominal Pain

 In general, pain in the epigastric area points towards organs like the stomach, duodenum, pancreas, gallbladder and the liver. Diseases such as stomach ulcer, stomach cancer, duodenal ulcer, pancreatitis, pancreas cancer, cholecystitis or biliary colic would present as pain in this area.

Pain around the umbilicus point towards the small bowel, appendix and the right side of the colon. Early appendicitis would be felt in this area.  Diseases of the small bowel like Crohn’s disease would also be felt here. 

Pain in the lower abdomen would point towards diseases involving the colon, the female reproductive system, and the urinary bladder. Cancer of the colon, ulcerative colitis, pelvic inflammatory disease, and ovarian mass would sometimes present as pain in this area.

 Symptoms Of Abdominal Pain

The tempo and duration of pain give important information. Persistent pain, even when not severe, point towards a problem that does not go away such as cancer or chronic inflammation. On the other hand, pain that comes in waves usually is associated with contraction of a hollow organ such as the colon or the gallbladder.

Associated symptoms are important as well. Loss of weight, loss of appetite, difficulty swallowing, change in bowel habit, recurrent vomiting, blood in stool and black stool all point towards serious disease such as cancer. The presence of any of these symptoms warrants urgent evaluation by a trained gastroenterologist. Fever, lethargy, generalized weakness and blood in stool points towards an inflammatory process and inflammatory bowel disease or infection needs to be excluded.

Some of the pain has clear precipitating factors and some do not. Some of the pain may worsen with stress. Some of the abdominal pain is more complex and may not conform to any particular pattern. The journey to discover the cause of these pain can be challenging. Some abdominal pain may even have a psychological component.

 Diagnosing Abdominal Pain

Correct diagnosis of the abdominal pain is important. Correct diagnosis leads to correct treatment and resolution of the symptoms.

The diagnosis of abdominal pain often requires careful and detailed history taking, paying attention to the site, duration, severity of the pain as well as the associated symptoms. Physical examination may sometimes be helpful. Specialists in gastroenterology can also conduct further investigations such as blood test, CT scan, gastroscopy and colonoscopy which may be necessary.

If you experience abdominal pain that could not be resolved with treatment with your family doctor, you probably would benefit from an expert evaluation from a specialist. You should not delay the evaluation for more than 2-3 weeks to ensure that there is no delay in diagnosis.


If you have persistent abdominal pain, do not just ignore it. Get a proper diagnosis to ensure that there is no serious illness. The medical cost is often fully covered by the majority of medical insurance and most clinics and government hospitals in Singapore do offer very affordable care. 


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


Gastroscopy is sometimes known also as an upper GI endoscopy. It is a procedure to examine the esophagus, stomach and the start of the small intestine (duodenum) with the use of an instrument called the gastroscope. The gastroscope has a long, thin and flexible tube with camera systems and capabilities to perform procedures such as biopsy and removal of polyps.

It is done by a gastroenterologist, who is a specialist with years of special training. It is usually done in the endoscopy center or operating theater of the hospital. Usually, the examination is done under moderate sedation, which means that you are “sleeping” during the procedure and will not remember the procedure.

Most of the time, gastroscopy is superior to X-rays, since the doctor can see more clearly.


The endoscopist passes the gastroscope through the esophagus into the stomach and duodenum. The upper digestive tract is washed clean and examined in detail. The examination would also involve the use of narrowband imaging (special light) to detect pathology that would otherwise be invisible. Various procedures can be performed through instruments that are passed through the gastroscope:

  • Biopsies: These would be done in a systematic manner or guided by enhanced imaging systems
  • Polypectomy: large polypoidal lesions can be removed with the use of endoscopic snares.
  • Injection of glue: histoacryl glue injection can be used to stop bleeding from abnormally enlarged vessels in the stomach called gastric varix.
  • Argon-plasma-coagulation (APC) can be used to obliterate small bleeding vessels or lesions.
  • Hemoclip application: Commonly used to stop bleeding from arteries.
  • Hemospray can be used to stop upper digestive tract bleeding.
  • Ligation of esophageal varices (abnormal enlarged blood vessels in the esophagus) to stop or prevent bleeding
  • Removing foreign body
  • Inserting feeding tubes
  • Performing dilatation and stenting (for the advanced endoscopist only)


The gastroscopy helps with the diagnosis and assessment of digestive illness such as:

  • Stomach ulcer or duodenal ulcer
  • Cancer of the esophagus and stomach
  • Gastroesophageal reflux disease (GERD)
  • Gastritis
  • Gastric polyps
  • Iron deficiency anemia

It can also aid to sort out symptoms such as:

  • Heartburn
  • Difficulty swallowing
  • Persistent or recurrent vomiting
  • Bloatedness
  • Epigastric pain
  • Weight loss

Preparing for Gastroscopy

You should fast for at least 6 hours prior to your gastroscopy. Longer fasting may be needed if your doctor suspect that your stomach is not emptying properly. You may drink clear fluid up to 2 hours before the procedure but milk is not allowed during the fasting.

In general, most medication should be continued before the gastroscopy with the exception of diabetes medication and blood thinners. Diabetic medication should be omitted during the fasting. You should check with your doctor if your blood thinner needs to be discontinued prior to the procedure.

As you will be given medication to make you sleepy, you must not drive, work or make any important decision after the procedure. Medical Certificate will be issued if needed and you should rest at home for the rest of the day.

Before the Gastroscopy

A nurse will conduct final checks, and bring you into the procedure room. An intravenous line will be inserted.

During the Gastroscopy

A throat spray will be administered to lessen the discomfort of the procedure.

You will be lying on your left, with your legs curled up and a plastic bite will be placed between your teeth to protect your teeth.

Sedation will then be given. After you have fallen asleep, the procedure will begin. You will likely not remember any of the procedure. You will be breathing on your own and monitored closely during the procedure.

You will wake up gradually after the procedure is done. All the medication used for sedation have a duration of action of a few minutes.

After the Gastroscopy

You will be cared for in a recovery area or room. The nurses will give you food and drink when they assessed that you are ready. You should arrange for a family member to take discharge instruction and take you home. You should only resume working and driving the following day.

Sometimes, you may have a mild sore throat, bloating and cramp. This normally goes away after 24 hours.


Gastroscopy is a very safe examination. Complication happens only very rarely.

Despite the best of intention and effort, sometimes issues do happen. There are:

  • A tear in the intestinal wall (which may need surgery to fix)
  • Bleeding
  • Allergic reaction to medication

If you have any concern after the gastroscopy, you should contact your doctor.


Quality of the gastroscopy depends mainly on the doctor conducting the examination. The doctor should be well trained in a recognized institution and have done adequate numbers.

A good documentation should have an adequate number of pictures to cover the entire upper GI tract. The picture should be clear and of good quality. The stomach should be well distended  and washed clean to enable proper examination. Image enhancement should be used when appropriate. Labeling of the pictures is also helpful.

Under adequate sedation, there should be minimal discomfort during the procedure. The doctor should also ensure that the sedation is carried out in a safe manner. There should be adequate monitoring after the procedure.

Rarely, you may have complications that needs care that only a hospital can provide. Easy access to a hospital is preferable.

Cost Of Gastroscopy and How to Choose

A certain proportion of the cost of gastroscopy is covered with Medisave deduction in Singapore. Many company health insurances and private health insurances also will cover the cost of the procedure. Most gastroscopies are done with diagnostic intent so you should choose specialist specialized in sorting out digestive symptoms. In Singapore’s context, such specialist would be a gastroenterologist.

Click here to find out on the preparation of your procedure. 

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