Inflammatory Bowel Disease (IBD) Treatment in Singapore

Most patients with IBD are initially managed with medication to help control symptoms and inflammation. The approach may differ depending on the type and severity of the condition, as well as individual needs.

Aminosalicylates (5-ASA) are commonly used for mild to moderate ulcerative colitis. These anti-inflammatory medications act on the intestinal lining to reduce inflammation. They are available in oral and topical (enema or suppository) forms, are generally well-tolerated, and may be used to help maintain remission.

Corticosteroids can help manage acute flares by reducing immune system activity. They may be suitable for short-term use but are generally not recommended for long-term maintenance due to potential side effects, including bone loss, weight gain, and increased risk of infection.

Immunomodulators such as azathioprine, mercaptopurine, and methotrexate reduce immune system activity. These medications take several weeks to months to reach full effect and may be used to help maintain remission and reduce steroid dependence.

Biologic medicines are another group of treatments that target specific parts of the immune response involved in inflammation. These are usually given by injection or infusion and tend to be considered when symptoms are moderate to severe or continue despite other treatments.

Surgery may be considered when medications do not adequately control the disease or when complications develop. The approach depends on the type of IBD, disease location, and individual factors.

Ulcerative Colitis Procedures

• Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA): Removes the colon and rectum, with an internal pouch created from the small intestine to help maintain bowel function.
• Total Colectomy: Removal of the colon, sometimes performed with a temporary ileostomy before further reconstruction.

Crohn’s Disease Procedures

• Small Bowel Resection: Removal of diseased intestinal segments while preserving a healthy bowel. The remaining ends are reconnected.
• Colectomy: Partial or complete removal of the colon, depending on disease extent and severity.
• Strictureplasty: Widens narrowed bowel areas without removing tissue, helping to preserve bowel length.
• Fistula Surgery: Addresses abnormal connections between the bowel and other structures through drainage, seton placement, or resection of affected segments.

Surgery for Crohn’s disease does not cure the condition, as inflammation may recur. Laparoscopic techniques may be used when appropriate, though open surgery may be necessary for complex cases.

• Endoscopic Balloon Dilation: Uses a balloon catheter to stretch and widen strictures in the digestive tract. May be suitable for short, non-inflammatory strictures.
• Endoscopic Mucosal Resection: Removes abnormal tissue or precancerous lesions from the intestinal lining during surveillance procedures.
• Endoscopic Stricture Management: May include balloon dilation, endoscopic incision, or temporary stent placement in selected cases.

These procedures are typically performed as day cases and may help avoid or delay surgery in appropriately selected patients.

Before starting IBD treatment, a thorough evaluation is performed to confirm the diagnosis and assess the extent of the disease. This typically involves:

Diagnostic testing includes blood tests measuring inflammation markers such as CRP and ESR, which indicate levels of inflammation in the body, complete blood count, and liver function tests. Stool tests help exclude infections and measure calprotectin levels, a protein that indicates intestinal inflammation.

Endoscopic evaluation via colonoscopy and, if indicated, upper endoscopy allows direct visualisation of the digestive tract. During these procedures, the colorectal specialist takes small tissue samples for examination under a microscope to confirm the diagnosis and rule out other conditions.

Imaging studies such as CT or MRI enterography provide detailed views of the small bowel and help identify complications such as strictures, fistulas, or abscesses. These non-invasive tests complement endoscopic findings.

Patients starting biologic therapy are screened for tuberculosis, and hepatitis B is required before treatment begins. Healthcare providers also review vaccination status and provide any necessary immunisations before starting immunosuppressive treatment.

The initiation phase is tailored to your specific treatment plan, with your specialist providing guidance on dosing, monitoring, and potential side effects.

• Oral Medications: These are usually started at home, with clear instructions regarding timing and food interactions. Some medications may require a gradual increase in dosage to minimise side effects.
• Biologic Therapies: Treatment often begins with more frequent loading doses before transitioning to a long-term maintenance schedule. These are administered via subcutaneous injection, for which you will receive self-injection training, or through intravenous infusion at a clinic or hospital.
• Surgical Procedures: If surgery is required, it is performed under general anaesthesia. Laparoscopic techniques may be used when appropriate, offering smaller incisions and typically shorter recovery times, although open surgery may be necessary for more complex cases.

• Monitoring: Your specialist monitors your response to new medications and checks for any adverse reactions through regular follow-up appointments.
• Surgical Recovery: Hospital stays usually last several days to focus on pain management, early movement, and a gradual return to a normal diet.
• Post-Op Care: The specialist may use temporary drains and will provide specific wound care instructions before discharge.