Crohn’s Disease Is No Longer Rare in Singapore. Here Is What You Need to Know.

Bloating, cramps, diarrhoea — most of us dismiss these up to something we ate or a rough week at work. But when these symptoms keep coming back, month after month, your gut may be trying to tell you something more serious. Crohn’s disease is on the rise in Singapore, and many people live with it for years without knowing.

If you have been brushing off recurring stomach complaints, it may be time to pay closer attention. Crohn’s disease does not just cause uncomfortable symptoms; it can silently damage your digestive tract for years. And the tricky part? You often cannot feel it happening.

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“I Thought It Was Just Stress”

Here’s a situation that plays out in gastroenterology clinics across Singapore all the time:

Someone comes in after months, sometimes years of recurring stomach pain, loose stools, and that bone-deep tiredness they could not explain. They would put it down to stress, or simply a sensitive stomach. By the time they finally get it checked, the inflammation had been quietly doing damage the whole time.

That is the tricky thing about Crohn’s disease. It can be subtle. It waxes and wanes, flaring up, then settling. So many people convince themselves they’re fine in between episodes.

They are often not fine. They just cannot feel what is happening inside.

So What Exactly Is Crohn’s Disease?

Crohn’s disease is a type of inflammatory bowel disease (IBD) — a condition where your immune system mistakenly attacks the lining of your digestive tract, causing ongoing inflammation. Unlike Ulcerative Colitis, which only affects the large intestine, Crohn’s can show up anywhere from your mouth to your anus.

And it does not just irritate the surface. The inflammation goes deep through all the layers of your bowel wall. That is what makes it so easy to underestimate. Over time, without proper treatment, it can cause serious structural damage.

Crohn’s most commonly affects the junction between the small and large intestine (called the ileocolonic region), but it can also affect just the small bowel, just the colon, or — in about 15% of cases — the area around the anus.

Think Of It Like A Leaking Pipe

Imagine a pipe in your wall that keeps slowly leaking. You cannot see it. You cannot hear it. But every week it goes unrepaired, the water is quietly warping the wood behind the wall — weakening the structure, causing damage that gets harder and harder to fix.

Crohn’s disease works the same way. Each episode of active inflammation, even a mild one — can leave a little more damage behind. The bowel wall thickens. Scar tissue builds up. The passage can narrow (called a stricture). Abnormal tunnels can form between loops of bowel or other organs (called fistulae). Over years, without good management, surgery may become necessary.

This is why gastroenterologists say something that surprises a lot of patients: how you feel is not a reliable guide to what is happening in your bowel. Research has shown that patients can feel perfectly fine. This is what doctors call “clinical remission” — while active inflammation is still quietly doing damage underneath.

Is It Becoming More Common in Singapore?

Yes, and the numbers are worth knowing. Crohn’s disease used to be considered rare in Asia. That’s no longer the case. Local data puts the prevalence in Singapore at about 7.2 in every 100,000 people — and it is rising. A major study published in Nature (2025), covering more than a century of IBD data across 82 countries, confirmed that rapidly developing nations in Asia are seeing a sharp climb in new cases. Urbanisation, dietary changes, and shifts in lifestyle all play a role.

Crohn’s affects men and women equally. It most often shows up between ages 15 and 30 — and again between 50 and 80. It does not discriminate by ethnicity or background. If you live in Singapore and you have had persistent gut symptoms you cannot explain, Crohn’s belongs on your radar.

What Are the Warning Signs?

One of the most frustrating things about Crohn’s is how different it looks from person to person. Because it can affect different parts of the digestive tract, the symptoms vary a lot — which is why it so often gets mistaken for IBS, food intolerance, or just “a sensitive stomach” for months or years.

Watch out for:

• Persistent or recurring abdominal pain and cramping
• Chronic diarrhoea, sometimes with blood or mucus
• Unexplained weight loss and a reduced appetite
• Persistent fatigue that does not go away with rest
• Pain, swelling, or discharge around the anus
• Symptoms outside the gut, like joint pain, eye inflammation, or skin changes

In more severe cases, there may be high fever, vomiting, or signs of bowel obstruction. These need urgent attention.

One thing worth remembering: these symptoms do not all appear at once, and they can come and go. Feeling better for a few weeks does not mean the disease has resolved. It may simply be in a quieter phase.

Here Is the Part That Surprises Most People

Feeling okay does not mean you are okay.

Studies have consistently shown that patients with Crohn’s disease can feel well, in what doctors call “clinical remission” — while still having active inflammation visible on scans or during colonoscopy. It is not something you can sense. It just quietly continues.

And here’s why that matters: silent inflammation still causes cumulative damage. Strictures. Fistulae. Bowel wall thickening. All of it builds up gradually while you go about your day, thinking everything’s fine.

A landmark clinical trial called the CALM Study compared two groups of Crohn’s patients. One group was managed based on symptoms alone. The other was monitored using objective markers — a blood test (CRP) and a stool test (faecal calprotectin) — and treatment was adjusted based on those results, not just how the patient felt. The tightly monitored group did significantly better. More mucosal healing. Less need for steroids. Better long-term outcomes.

The lesson? Your symptoms tell part of the story. Your test results tell the rest.

How Do Doctors Actually Diagnose It?

There is no single test that confirms Crohn’s disease. It takes a combination of investigations, which is why the process requires patience and a thorough doctor.

One thing that is particularly important in Singapore: tuberculosis (TB) can look remarkably similar to Crohn’s disease, so ruling it out is an essential first step here. This involves stool cultures, parasite testing, and biopsies specifically tested for TB.

1. Ileocolonoscopy with Biopsy (The Gold Standard)

A colonoscopy that extends into the lower part of the small bowel allows your doctor to see the bowel lining directly and take tiny tissue samples. It is the most definitive way to confirm the diagnosis, understand how severe things are, and check for complications. Yes, the prep is annoying. But it is irreplaceable.

2. MR Enterography (The Radiation-Free Scan)

A specialised MRI of the small bowel gives detailed images of the bowel wall, any fistulae, strictures, or abscesses — without any radiation. Because Crohn’s is a lifelong condition that requires repeated monitoring, this matters enormously. Research has found that about 1 in 10 Crohn’s patients accumulates a concerning level of radiation exposure from CT scans over time. MR Enterography is now the preferred option wherever possible.

3. Faecal Calprotectin (The Home Test)

You collect a small stool sample at home, send it to the lab, and they measure inflammation markers. If the level is elevated, it means there is active inflammation — even if you feel completely fine. Think of it as your early warning alarm between clinic visits.

4. Blood Tests

CRP, full blood count, and albumin levels give your doctor a sense of how much inflammation is present and whether your nutrition is being affected. They are not enough on their own, but they’re an important piece of the puzzle.

What Are the Treatment Options?

Crohn’s disease cannot be cured, but it absolutely can be managed. Treatment is always tailored to the individual — based on where the disease is, how severe it is, and what’s realistic for your life. The goal is to get the disease into remission (symptoms gone and inflammation controlled) and keep it there, so your bowel has the best chance of healing and long-term complications are minimised.

Steroids

Used for short-term flares to bring inflammation down quickly. They work well, but they are not for long-term use and they do not prevent future complications.

Immunosuppressants

Medications like azathioprine and methotrexate calm the overactive immune response and help maintain remission over time. Often used alongside biologic therapies.

Biologic Therapies

For moderate to severe disease, biologic medications target specific inflammatory pathways. Anti-TNF agents, vedolizumab, and ustekinumab are among the options — and they’re the current standard of care for patients who need more than conventional treatment. Because some of these can reactivate latent TB, proper screening before starting is essential — especially in Singapore.

Nutritional Support

Nutritional deficiencies are extremely common in Crohn’s disease, because the inflamed bowel absorbs less. A dietitian familiar with IBD is an important part of the team. In some patients, a medically prescribed liquid diet can help induce remission — particularly in younger patients.

Surgery

Sometimes needed when complications like strictures, abscesses, or fistulae do not respond to medication. Surgery does not cure Crohn’s, but it can provide real relief. After surgery, ongoing medication and monitoring are essential to reduce the risk of recurrence.

Living Well With Crohn’s Disease

A diagnosis of Crohn’s disease is life-changing, but it does not have to mean a diminished life. Many people manage the condition well and stay active, social, and working with the right support.

A few things that genuinely make a difference:

• Do not rely on symptoms alone to judge your disease activity. Regular monitoring — stool tests, blood tests, and periodic colonoscopy or MRI — is how you stay ahead of it.
• If you smoke, stop. Smoking makes Crohn’s significantly worse — more flares, more complications, higher surgery risk. It’s the single most impactful lifestyle change you can make.
• Keep taking your medication, even when you feel great. That is what remission looks like. Don’t stop it.
• Talk to your doctor about vaccinations. Some Crohn’s medications suppress your immune system, which affects what vaccines are safe. Your gastroenterologist can guide you.
• Get a dietitian involved. Nutritional gaps are common and often overlooked. Addressing them makes a real difference to how you feel day to day.

When Should You See A Doctor?

If any of these have been going on for more than a few weeks, book an appointment. Do not put it off.

• Persistent diarrhoea, with or without blood
• Recurring abdominal pain that keeps coming back
• Unexplained weight loss
• Fatigue that doesn’t get better with rest
• Perianal pain, swelling, or discharge

Go to A&E immediately if:

• Severe abdominal pain that comes on suddenly
• Fever above 38°C with abdominal pain
• You are vomiting and can’t keep fluids down
• You suspect your bowel might be blocked

With conditions like Crohn’s disease, early intervention is not just advisable, it is genuinely protective. The sooner the inflammation is found and treated, the less damage accumulates, and the more treatment options stay open to you.

Do not wait until things get bad. Your future self will thank you.

This article is contributed by Dr Juanda Leo Hartono, a Gastroenterologist with extensive training in inflammatory bowel disease, colorectal cancer and advanced endoscopy. Patients benefit from his evidence-based care and deep understanding of complex gastrointestinal and liver conditions.

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About Juanda Leo Gastroenterology Liver Clinic

Dr Juanda Leo Hartono

Dr Juanda specialises in digestive system and liver problems. He is a senior consultant at Mount Elizabeth Hospital with over 15 years of experience.

After training at University Malaya and National University Hospital, he did advanced fellowship training at The Royal London Hospital in the UK. At NUH, he was the IBD lead and Clinical Director of Gastroenterology.

He still works as a visiting consultant at NUH and recently contributed to major research published in Nature journal about IBD trends worldwide.

What They Offer

Juanda Leo Gastroenterology Liver Clinic provides everything from endoscopies (gastrocopy, colonoscopy, enteroscopy) to advanced scans (ultrasound, Fibroscan, CT, MRI), capsule endoscopy, and specialised Crohn’s disease treatment including biologic therapies.

Their approach? They do not just ask how you feel. They use endoscopy results, imaging, stool tests, and blood tests to make sure your treatment is actually keeping the inflammation under control — the kind of remission that lasts.

Feeling fine is wonderful. But feeling fine and being truly healed are two different things.