19 Questions answered

Is there a test for SIBO in Singapore?

The best test for SIBO today is combined hydrogen methane breath testing using glucose as a substrate. Its effectiveness is proven in multiple studies in well established journals. It is able to detect SIBO in both hydrogen and methane producers, and is very accurate. It is simple and usually conducted in a clinic setting. This test has become available in Singapore in the past 3-4 years. It is available in the some of the tertiary hospitals in the public sector, including SGH, NUH, TTSH and CGH. In the private sector, this test is available in gutCARE, our digestive group practice.

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Answered By

Dr Jarrod Lee

Gastroenterologist

Can I take laxatives if I'm trying to conceive?

Pregnancy is a risk factor for constipation. Many of our patients with constipation complain that it worsens with pregnancy. In these cases, they may have to take laxatives to help with the constipation symptoms. Usually, we choose simple and safe laxatives that stay only in the gut and do not enter the body per se. for example, a stool softener like lactulose. Simple lifestyle measures are crucial, including adequate water and fibre intake, and regular exercise. Senna and other laxatives do not affect fertility. Senna appears to be safe and does not appear to harm the fetus in animal studies.

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Answered By

Dr Jarrod Lee

Gastroenterologist

Can Hepatitis B be transmitted during IVF?

Hepatitis B is transmitted from mother to child at birth, not at the time of conception. Hence, Hepatitis B is not an issue for IVF, as the virus cannot be transmitted at IVF. If the IVF is successful, you would be no different from many other Hepatitis B mothers. To prevent transmission at birth, your baby will need Hepatitis B vaccination and immunoglobulin within 12 hours of birth. During pregnancy, your obstetrician will monitor your liver function and Hepatitis B viral load.

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Answered By

Dr Jarrod Lee

Gastroenterologist

What to do when experiencing diarrhoea as a side effect of antibiotics after discharge from hospital?

Diarrhea is one of the most common side effects of antibiotics. The first step is to contact the doctor prescribing the antibiotic to ascertain the importance of the antibiotic, and whether there is a suitable alternative. If the antibiotic needs to be continued, one should ensure that the patient is suitably hydrated and rested. Avoid milk and dairy products, as well as oily foods. Anti-diarrhea medication can help to improve the symptoms while the patient is undergoing treatment.

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Answered By

Dr Jarrod Lee

Gastroenterologist

Why do I still get abdominal bloating after acid reflux treatment?

Pain and burning sensation are recognized as symptoms of acid reflux, and will hence improve with PPI treatment. However, bloating is not a symptom of acid reflux. Hence, PPI treatment will not have any effect on it. The commonest causes of bloating we see locally in our clinics are: food intolerance, bacterial overgrowth and constipation. Food intolerance alone accounts for over 50% of bloating. Certainly, there are other causes of bloating, including more serious causes, but these are uncommon.

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Answered By

Dr Jarrod Lee

Gastroenterologist

When is a scope recommended for gastric issues such as bloatedness and wind in the stomach?

Professional societies have published several international recommendations on the need for gastroscopy. These are based on good research, and are updated periodically. In general, bloating and excessive belching alone is not a reason for gastroscopy, neither is acid reflux unless treatment has failed. Bloating, excessive belching and acid reflux are common symptoms. Gastroscopy is a procedure that is done to establish a diagnosis, and does not treat these symptoms. Bloating and excessive belching is most often due to food intolerance.

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Answered By

Dr Jarrod Lee

Gastroenterologist

Why do I feel bloated even after small meals?

The commonest cause of bloating is a food intolerance. The problem is not the size of the meal, but that you are probably eating food that you are not able to digest without being aware of it. The undigested food is then metabolized to hydrogen and methane gases by gut bacteria and causes bloating. Certainly reducing carbonated drinks will help to reduce the gas, but the most important thing is to identify what you are eating that you are intolerant to and that, hence, causes bloating. Our clinics employ 2 strategies for our bloated patients: 1.

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Answered By

Dr Jarrod Lee

Gastroenterologist

Who should go for a gastroscopy?

Thanks for the D2D. Unlike colonoscopy, ‘routine’ gastroscopy for general screening is not proven. I typically advise 2 groups of people to go for ‘screening’ gastroscopy. 1. Patients with symptoms that may be due to disorders of the upper digestive tract, as the gastroscopy may be able to diagnose a problem to allow treatment and prevent it from getting worse.

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Answered By

Dr Jarrod Lee

Gastroenterologist

What is the purpose of a gastroscopy?

Gastroscopy is used to examine the organs of the upper digestive tract: the oesophagus, stomach and duodenum (it's the first and shortest segment of the small intestine). I perform gastroscopy for 3 groups of patients: Patients with symptoms that may be due to disorders of the upper digestive tract. I use gastroscopy to examine the internal lining of the oesophagus, stomach and duodenum for disorders. I may also obtain tissue biopsies to allow further examination of cellular structures under a microscope by a pathologist.

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Answered By

Dr Jarrod Lee

Gastroenterologist

How painful is a gastroscopy, and what kind of sedation is used during the procedure?

Thanks for the D2D. Gastroscopy is usually performed under moderate or ‘conscious’ sedation. This is a state where patient is ‘put to sleep’ or sedated, but can be respond purposefully when called or touched. The medication is given through an intravenous line, and I adjust the dose accordingly to achieve the desired state of sedation. This way, I ensure that just enough sedation is given, and I avoid the side effects and complications of the medication. Most of my gastroscopy procedures are completed within 15 minutes, so the total dose of medication I give is low.

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Answered By

Dr Jarrod Lee

Gastroenterologist

How much does a gastroscopy cost in Singapore, and is it Medisave claimable?

Hi Yun Ling, Thanks for the D2D. Based on the MOH website on October 2018, the median cost of a standard diagnostic gastroscopy performed as day surgery ranges from $300 to $910 for subsidized patients, depending on the hospital. Medisave can be used to cover the cost of gastroscopy. For standard diagnostic gastroscopy performed as day surgery, up to $650 may be used. In most cases, this is sufficient to cover the entire cost if performed as a subsidized case in a public hospital. However, the cost of gastroscopy is highly variable, depending on who and where it's performed.

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Answered By

Dr Jarrod Lee

Gastroenterologist

What will happen if the gastroscopy shows an abnormality?

Thanks for the D2D. When I find an abnormality, I will do the following: Make an endoscopic diagnosis. In many conditions, a good endoscopic diagnosis and picture documentation is sufficient to proceed to management. Try to find an underlying cause of the condition. For example, if there is a stomach ulcer, I will look for an underlying infection which may have caused the ulcer. Assess the severity of the condition and look for associated complications. Determine whether tissue biopsy is needed, and obtain the appropriate samples if so.

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Answered By

Dr Jarrod Lee

Gastroenterologist

How is a gastroscopy performed, and what can be expected during the procedure?

Hi Yang Meng, Thanks for the D2D. During the actual procedure, I always start by spraying a local anaesthetic to numb the back of the throat. The patient then lies on the left side, and I give medication through an intravenous line to put the patient to sleep. Once the patient is adequately sleepy, I'll pass the gastroscope through the mouth into the oesophagus, stomach, and duodenum (it's the first and shortest segment of the small intestine). The gastroscope is a long thin flexible tube with a camera and light source at the end.

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Answered By

Dr Jarrod Lee

Gastroenterologist

What does it mean if I have a fatty liver, and how dangerous is that for my health?

Fatty liver is a common disorder where there is accumulation of excess fat in the liver. In people who drink little or no alcohol, this is called NAFLD or Non Alcoholic Fatty Liver Disease. This condition is usually not serious, and the fat does not damage the liver. However, a small group of people with NAFLD may develop a more serious condition called NASH or Non Alcoholic Steato Hepatitis. In this condition, the fat accumulation results in liver damage and scarring.

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Answered By

Dr Jarrod Lee

Gastroenterologist

How can I best prepare for a gastroscopy?

Thanks for the D2D. Preparation for gastroscopy is surprisingly simple. My patients are allowed to take a light meal 6 hours or more before the procedure. Clear liquids such as water, fruit juice without pulp and carbonated beverages may still be taken until up to 2 hours before the gastroscopy. In certain cases, I may recommend a longer fasting period, for example, after heavy meals or in patient with slow stomach emptying. Although the fasting preparation is very simple, it is crucial to allow clear visualization of the stomach to enable accurate diagnosis and treatment.

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Answered By

Dr Jarrod Lee

Gastroenterologist

Practice

38 Irrawaddy Road Mount Elizabeth Novena Specialist Centre #10 - 58 Singapore 329563

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* This profile has been last updated on August 26, 2020.