Doctor examining an illustration of the colon

Dr Kieron Lim

Senior Consultant Gastroenterologist & Hepatologist

MBBS, University of London, Member, Royal College of Physicians (UK), Fellow, Academy of Medicine (Gastroenterology) Singapore, Fellow, Royal College of Physicians (Edinburgh)

Being diagnosed with inflammatory bowel disease (IBD) can leave you uncertain about what treatment involves and whether your symptoms can be brought under control. IBD mainly includes Crohn’s disease and ulcerative colitis, both of which can vary in location and severity. As a result, there is no single treatment plan that suits everyone.

When planning your care, your gastroenterologist will consider the type of IBD you have, the location and extent of inflammation, its severity, any complications, your wider health and how you have responded to previous treatment. Understanding how your doctor makes these decisions can help you approach treatment with greater clarity and confidence.

What Are the Main Goals of Inflammatory Bowel Disease Treatment?

The first goal of inflammatory bowel disease treatment is to reduce active inflammation, relieve symptoms such as abdominal pain, diarrhoea and rectal bleeding, and bring the condition into remission.

Symptom improvement is an important sign of progress, but it does not always mean that the inflammation has fully resolved. Doctors may therefore also assess whether the bowel lining is healing, as persistent inflammation can cause complications even when symptoms have become less noticeable.

Once remission has been achieved, the focus shifts to maintaining it. Longer-term treatment aims to prevent flare-ups, avoid prolonged corticosteroid use, preserve bowel function and reduce the likelihood that a patient will need hospitalisation or surgery. Ultimately, this treatment should help patients return to their usual daily activities.

How Do Doctors Decide Which IBD Treatment Is Appropriate?

Doctors first determine the type, location and severity of inflammatory bowel disease before recommending treatment. They also consider whether complications are present and how the condition has responded to previous care.

Is It Crohn’s Disease or Ulcerative Colitis?

Crohn’s disease and ulcerative colitis affect the digestive tract in different ways. Ulcerative colitis affects the colon and rectum, while Crohn’s disease can develop anywhere along the digestive tract and may affect deeper layers of the bowel wall.

These differences influence which medicines may be suitable, how treatment is given and how doctors approach possible complications. They also affect the role of surgery, as removing the colon can eliminate ulcerative colitis but surgery cannot cure Crohn’s disease.

Where Is the Inflammation and How Extensive Is It?

The location and extent of inflammation help determine how treatment should be delivered. For example, ulcerative colitis may be limited to the rectum, affect the left side of the colon or extend throughout most of the colon. Treatment may be given orally, rectally or through a combination of both, depending on the areas involved.

Crohn’s disease may affect the small intestine, colon or both. Some patients may also develop inflammation or fistulas around the anus, known as perianal Crohn’s disease, which may require a different treatment approach.

How Active or Complicated Is the Disease?

Doctors determine the severity of IBD by assessing the patient’s symptoms together with blood tests, stool tests, endoscopy and imaging where appropriate. More active inflammation may require treatment that acts more quickly or has a stronger effect on the immune system.

Doctors also look for complications such as bowel narrowing, fistulas, abscesses, significant bleeding and nutritional deficiencies. Their presence may change the treatment plan and sometimes require hospital care or surgery.

Which Patient-Specific Factors Need to Be Considered?

Treatment should also account for the patient’s wider health and circumstances. A gastroenterologist may consider:

Which treatments have already been tried and how well they worked
Previous side effects or medication allergies
Other health conditions and current medications
The risk of infection
Pregnancy or family-planning considerations
How practical the treatment will be to follow

These factors help the doctor balance the likely benefits and risks of each option and develop a treatment plan that is appropriate for the individual patient.

How Do Doctors Monitor Whether IBD Treatment Is Working?

Your IBD specialist can monitor treatment by comparing changes in your symptoms with tests that measure inflammation and show whether the bowel is healing. They may ask about abdominal pain, bowel habits, rectal bleeding, appetite, weight and the effect of the condition on your daily life.

You may also need further testing, which can include:

Blood tests to look for inflammation, anaemia, nutritional problems or possible treatment side effects.
Stool tests to check for inflammation in the bowel or rule out an infection.
A colonoscopy or other camera test to examine the bowel lining and see whether it is healing.
MRI, CT or ultrasound scans to examine areas of the bowel that may not be clearly seen during a colonoscopy, particularly in Crohn’s disease.

The improvement of symptoms does not necessarily mean that inflammation has completely subsided. Your gastroenterologist will review your symptoms alongside your test results to determine whether the treatment is working. If inflammation remains, they may adjust your dosage, change your medication or recommend another treatment.

When Might Hospital Care or Surgery Be Needed for IBD?

If a severe IBD flare-up cannot be managed safely through outpatient treatment, you may require hospital care. This could occur if you experience:

Persistent bleeding
Severe abdominal pain
Dehydration
Difficulty eating or drinking
Severe inflammation that remains uncontrolled despite treatment
Complications such as bowel narrowing, fistulas or abscesses

Surgery is not required in every case. However, your doctor may recommend it if medication cannot adequately control the inflammation or if a serious complication needs to be treated directly.

Surgery to remove the affected colon and rectum can prevent ulcerative colitis from returning in the removed bowel, while Crohn’s disease may return elsewhere after surgery.

A gastroenterologist reviewing the results of a patient’s assessment

When Should You Consult a Gastroenterologist About IBD Treatment?

You should consult a gastroenterologist if digestive symptoms persist, keep returning or begin to interfere with your daily life. This includes situations where:

Abdominal pain, diarrhoea or rectal bleeding does not improve
Your symptoms disrupt your work, sleep, meals or social activities
You are losing weight or struggling to eat normally
Flare-ups are becoming more frequent or severe

At Kieron Lim Gastroenterology, Senior Consultant Gastroenterologist & Hepatologist Dr Kieron Lim provides assessment and ongoing care for patients with Crohn’s disease and ulcerative colitis. Dr Lim considers the type and extent of IBD, the severity of inflammation, previous treatment response and your wider health before recommending a treatment plan. He also monitors your progress so that treatment can be adjusted when necessary.

If you are seeking an assessment for ongoing digestive symptoms, starting treatment after an IBD diagnosis or reviewing a current treatment plan, contact us today to arrange a consultation with Dr Lim.

Meet Our Doctor

Dr Kieron Lim

Senior Consultant Gastroenterologist & Hepatologist

MBBS, University of London Member, Royal College of Physicians (UK) Fellow, Academy of Medicine (Gastroenterology) Singapore Fellow, Royal College of Physicians (Edinburgh)

Dr Kieron Lim is a senior consultant specialising in Gastroenterology and Hepatology, providing comprehensive care for patients with gastrointestinal conditions in Singapore. His expertise extends to disorders affecting the oesophagus, stomach, colon, liver, pancreas and gallbladder. Through his experience, Dr Lim enhances patient outcomes by facilitating early detection and timely medical interventions.

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