That Gut Feeling - when do digestive problems need medical attention? 

Lance Alexander (0:01)

Best of Live Well ft. Lance Alexander.

Good morning Singapore. Heartburn, acid reflux, bloating, constipation.

When should we stop treating these ourselves and see a doctor? Digestive health covers more than the stomach and our bowels. It also includes the liver, pancreas and the gallbladder. Not treated properly may lead to complex diseases such as cancer of the stomach, bowel, liver, pancreas and bile ducts. Woodlands Hospital's new Digestive Health Centre brings specialist diagnostic tests and treatment together to help patients get coordinated care. To discuss common digestive problems in Singapore and how to get help, which symptoms should we take seriously? We have Dr. Christopher Chia, Chief of Gastroenterology and Hepatology and co-lead of the Digestive Health Centre, Woodlands Hospital, with us this morning. Dr. Chia, welcome to the show.

Christopher Chia (1:01)

Hey, good morning, Lance. Thanks for inviting me and then happy to be on board.

Lance Alexander (1:05)

Thank you, sir. Now, let's start with digestive problems you see on a regular basis here in Singapore. Who tends to be affected and are they more men or women?

Christopher Chia (1:16)

I think I would say equally, depending on whether you are talking about benign versus malignant conditions. Malignant are what we usually term cancerous conditions.

So if you are talking about something that a lot of people should be aware, and nowadays the talk of the crowd would be colorectal cancer, because that's the second most common cancer for both men and women.

For men, it would be the second after prostate cancer, and for women, it would be second after breast cancer. But of course, there are a lot of other benign conditions that can cause digestive health symptoms, as you mentioned. So overall, I would say in Singapore, or most parts of the world, 10 to 30% of patients tend to manifest digestive or what we call gastrointestinal GI symptoms. Ranging, if you go from the top to the bottom, from the esophagus or the gullet to the stomach, you have acid reflux, you have gastric ulcers, duodenal ulcers, and then small bowel, you have inflammatory bowel disease. More common in the West, but we are seeing more and more being picked up in Singapore in the local context. And of course, colon, we have changed in bowel habits that probably sometimes can be a manifestation of early colorectal cancer and anorectal bleeding, which is also a sign of colorectal cancer. So you can see through the gut from the mouth all the way down to the anus, we do have a myriad of symptoms that can give rise to problems in the community.

Lance Alexander (2:43)

You know, I'm just wondering, when exactly do we see a doctor? Because most people would just say, I've got a stomach upset and I'm just going to pop a few pills that I've got in the cupboard. And then next thing you know, it gives you some temporary relief. But when exactly should we say, maybe I should see a doctor about this?

Christopher Chia (3:03)

I think there's a very valid question, Lance. Most times, right, doctors would advise patients that, I mean, self-medication is not something uncommon. A lot of people do it, especially if the symptoms are mild and go away.

I think people have to get a bit more concerned if the symptoms stay on or when there are worrisome symptoms that don't go away readily or they keep recurring, right? What we call alarm symptoms. So when we tell patients or we tell our friends, family, alarm symptoms, what do they mean? Right? So alarm means something that is out of ordinary. So most times, it goes from the top to bottom too, especially when you have something sinister like vomiting blood, right? So it's something that no one expects, right? And then when you have unexplained blood loss and when you have unexplained weight loss, you're not eating well, you have persistent vomiting, right? It's not just from a bout of food poisoning and you vomited once, but it's persistent.

And then if you can't eat well after a while and when there's an abnormal change in bowel habit that persists, right? And there's pain, of course, right? Most people come because they have some what they call tummy pain or abdominal pain that does not go away with simple over-the-counter medications. So these are the few things that we tend to tell patients. You may not want to keep self-medicating. You may want to see a doctor.

Lance Alexander (4:22)

Okay. So when it comes to these symptoms, do you get similar sensations or signs, regardless of whether it's the stomach, intestines, liver, pancreas, gallbladder?

Christopher Chia (4:34)

I think they manifest a bit differently. So again, from top to bottom, if you are talking about gallbladder or what we call the esophagus, most times patients will have difficulty swallowing. They feel that the food gets stuck or they have an acid reflux producing heartburn, and then some sour juice are regurgitating up the throat, that's gallbladder. Stomach, usually they may come with some pain near where they usually point towards the abdomen.