By: LEA WEE
A chronic and incurable bowel disease, which used to plague mainly sufferers in the Western Hemisphere, is on the rise here, perhaps because of changes in genetics, diet and the environment.
The condition, which is incurable, can leave sufferers unable to work, leave home or even eat because of acute abdominal pain. It can also put some at risk of colon cancer.
Inflammatory bowel disease (IBD), which can lead to life-threatening conditions such as bowel perforation, is now estimated to affect about 25 in 100,000 people in Singapore.
That is two to five times as many sufferers as there were a decade ago, said Dr Kelvin Thia, a consultant at the department of gastroenterology and hepatology at the Singapore General Hospital (SGH).
It works out to about 1,000 to 1,500 people who find eating to be a misery and about 100 new cases joining their ranks every year.
Sufferers tend to be men in their 20s to 40s, with Indians appearing to be more vulnerable than Chinese or Malays.
The rising trend in IBD has also been noted in East Asian countries such as Japan, South Korea and Hong Kong, said Dr Thia, the main author of a paper on the subject published in the American Journal Of Gastroenterology in 2008.
At this rate, the prevalence of IBD in East Asia –- now about a tenth that in the United States and western Europe – may catch up with that of the West, he added.
In the last five or six years, SGH, Tan Tock Seng Hospital, National University Hospital and KK Women’s and Children’s Hospital have begun running weekly or monthly IBD clinics.
All six public hospitals – these four hospitals, Changi General Hospital and Khoo Teck Puat Hospital – are now collaborating to collect data on the extent of the problem here. The effort was initiated by SGH.
While IBD is not usually fatal, its rising trend is a concern because of its impact on a person’s quality of life, said Dr Thia.
As IBD is chronic and incurable, patients need to be on life-long follow-up and medication, which may not be subsidised because of the condition’s relative rarity.
Dr Jeannie Ong, a consultant in gastroenterology at Changi General Hospital, said IBD tends to hit someone at the peak of his life. The reason for this is not known.
He could be studying, starting a career or planning to have a family. The disease could wreck his ability to carry out these activities or plans.
In IBD, the immune system over-reacts to an offending agent such as bacteria or protein found in food. The immune cells attack the lining of the intestines, causing it to become inflamed and, in turn, creating symptoms such as diarrhoea and abdominal pain.
The trigger can be any kind of food but studies have shown that the more common irritants are refined sugar, meat and food that is high in fat content.
The inflammation can also spread to other parts of the body, causing fever, mouth ulcers, skin rash, eye and joint pain. It could also affect egg and sperm quality.
There are two main forms of IBD – Crohn’s disease and ulcerative colitis. Crohn’s disease, which tends to affect the small intestine, is more prevalent in the West and affects more young women than men.
In Singapore and East Asia, ulcerative colitis, which attacks the large intestine, is more common than Crohn’s disease.
Ulcerative colitis may also lead to more severe long-term health consequences. Those with ulcerative colitis, even if it has been treated, have about a 10 per cent risk of developing colon cancer after 20 to 30 years. An average Singaporean has a lifetime risk of about 2 per cent of developing colon cancer.
So patients need to go for regular colonoscopies to check for this form of cancer.
It is not clear why Asians have increasingly developed hyper-sensitive immune systems in the last 20 years. Part of the reason could be the genetic changes which take place in any species over time.
But these changes, which take centuries to show their effects, cannot adequately explain the rapid rise of IBD over the last two decades, said Dr Thia.
Some scholars argue that changes in diet and the environment have stoked the growth of IBD in the region.
They explained that as East Asian countries become increasingly developed, their populations switched to diets high in refined sugar, animal protein and fat.
Research suggests that such a diet somehow changes the mix of the bacteria that live in the gut such that it becomes more susceptible to inflammation, said Dr Thia.
A recent review of 10 international studies in the American Journal Of Gastroenterology found that a diet high in fat and meat was linked to an increased risk of IBD, while the opposite was true for a diet rich in fibre, fruit and vegetables.
A more controversial theory, the hygiene hypothesis, argues that as countries become more developed, their environments also become more sanitary.
As a result, people are less exposed to all kinds of bacteria, including those which could prime their immune systems against diseases, said Dr Thia.
The same hypothesis has been used to explain the rise in the number of people developing allergies such as asthma and eczema.
As research continues to search for the causes of IBD, advances have been made in its treatment, using medication and surgery to help patients regain a normal life.
Some studies indicate that if sufferers comply with treatment, they can live as long as anyone else, said Dr Thia.
The disease does not have to take over if a patient is able to control his condition and achieve remission as often as possible.
“I have IBD patients who take part in marathons or biathlons,” said Dr Thia.
They can also eat a normal diet, though people whose intestines have been constricted by the inflammation may need to avoid high-fibre food. These form larger stools which may have difficulty passing through the intestine.
The key problem with IBD here is not the lack of treatment but recognition, doctors said. People often dismiss their symptoms as an “upset stomach”, or think their bloody stools are a result of piles.
By the time they seek treatment, it could be months or even years since symptoms first surfaced, said doctors.
Dr Ong added that certain infections, such as tuberculosis, may mimic the symptoms of IBD and make its diagnosis difficult.
In any case, people should see a family doctor if they have had chronic diarrhoea more than three times a day for more than four weeks, she said. This is especially so if the diarrhoea happens at night.
The last thing people should do is to suffer in silence, said doctors here.
Dr Thia said: “There are many effective treatments out there which will help them to lead a normal life.”
Email: leawee@sph.com.sg
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