Lead: Qasim Aziz
Professor of Neurogastroenterology
Director of the Wingate Institute
Neurogastroenterology is a discipline of gastroenterology, aimed at understanding the neuromuscular control of gastrointestinal function, with particular emphasis on brain-gut interactions. The Neurogastroenterology Group is a multidisciplinary collaboration of experts, both clinicians and scientists, including adult and paediatric neurogastroenterologists, GI pathologists, physiologists, psychologists and psychiatrists, surgeons, immunologists, neuroscientists, and physicists. They are working across the Blizard Institute, Barts and The London School of Medicine and Dentistry, and Barts Health NHS Trust to advance basic scientific study and translate this knowledge to enhance patient care.
There are four major areas of our research on the gastrointestinal system: pain, neurodegeneration and ageing, reflux, obesity and connective tissue, all addressed by the neurogastroenterology group. The activities of the group span the disciplines of Gastroenterology, Gastrointestinal surgery, Psychiatry, Pharmacology, Neuroscience, Neurology, Immunology, Nutrition and Endocrinology. Many of our members are specialists in one or more of these areas and/or disciplines. The approaches comprise Molecular and Cellular, Experimental and Translational, and Population-based medicine, providing a vertical and horizontal matrix between our research themes. Our many collaborations clearly demonstrate the high level of national and international outreach. Our publication record emphasises our multidisciplinary approach. We provide state-of-the-art research facilities that promote sharing of resources within the campus. We have both individual and collective projects addressing four levels of investigation in each programme.
The four levels are:
Principal investigators: Gareth Sanger
Dr Nick Croft’s teaching role lies in organising the highly regarded MSc in Gastroenterology, which supports research both via projects run within the course and by attracting quality students to study for higher degrees. Recently, the Centre for Digestive Diseases has secured funding from the UEGF to develop a pan-European e-learning MSc programme in Gastroenterology, with neurogastroenterology being one of the main modules in this programme.
The GI Physiology Unit is an accredited national training facility. Dr Scott, Professor Sifrim and Dr Yazaki supervise the training of both internal and external practitioners (physiologists, nurses, physicians and surgeons) in GI physiological investigative techniques.
The senior faculty of the neurogastroenterology group supervise a number of graduate and postgraduate students. In addition to the 20 research fellows listed on this website, we have supervised numerous PhD students, MPhil students, MD students, and post-doctoral fellows in the past five years. Note: Prospective students should contact Professor Qasim Aziz at firstname.lastname@example.org to discuss possibilities for future research.
The Neurogastroenterology group is delivering an education programme through organisation of regular national and international meetings, seminars and workshops. Members of the group already have a leadership role in Education in Europe. Professor Aziz is a member of the executive committee and the lead for education for the European Society of Neurogastroenterology and Motility. He is also a member of the Executive Committees of the neurogastroenterology section of the British Society of Gastroenterology (BSG), and serves on the Education and Scientific Committee’s of United European Gastroenterology Federation (UEGF). Other members of the group such as Mr Knowles, Dr Scott and Professors Sifrim, MacDonald and Giovannoni also have leadership roles in education within UK and Europe.
Our educational programme has received support and sponsorship from the BSG, UEGF, and European Society of Neurogastroenterology and Motility, which has facilitated international meetings, workshops and seminars on a range of topics. Furthermore, The Centre for Digestive Diseases has recently secured funding from the UEGF to develop a pan-European e-learning MSc programme in gastroenterology, with GI neuroscience being one of the main modules in this programme.
Through our link with the SMD’s award winning outreach project called Centre of the Cell, we have engaged in seminars and ‘Meet the Investigator Meetings’ with local school children, regularly provide work experience opportunities, and are developing class room educational resources for school children. In addition, we are helping to develop ‘patient journeys’ (a web based educational programme for patients about what the patients should expect from the doctors and other hospital staff when referred to hospital for management of specific symptoms).
Collaboration with Dr Leslie Hill, Principal Research Fellow in performance technologies at East London University, and Dr Helen Paris, Reader in performance at Brunel University, has led to the development of a performance called ‘Gut feelings’ which has been staged nationally including at the Edinburgh Festival. Another play on the same theme called ‘From the moment I saw you I knew I could love you’ was developed by the Royal Shakespeare Company and premiered at the Chelsea Theatre in October 2009. A film called ‘Gut feelings’ is now in production with well-known British filmmaker Andrew Kötting. This research project is supported by a Wellcome Trust Arts Award and The Arts Council England (collaboration with Professor Aziz).
Barts Health NHS Trust has one of the premier gastroenterology departments in the country, with a wide referral base covering all aspects of the speciality.
Neurogastroenterology has traditionally been an area of strength within the gastroenterology department, and is unique in providing adult and paediatric medical and surgical clinics supported by the nationally eminent GI physiology diagnostic unit. The group has a long tradition (more than three decades) for receiving both national and international referrals for the diagnosis and treatment of patients with disorders of GI function.
Multidisciplinary joint clinics are now in place for complex patients, involving paediatricians, psychologist, psychiatrists and pain management specialists. Overall, all the combined clinics receive approximately 1,000 referrals per year providing a rich resource for clinical research. The new hospital being built at the Whitechapel site is state-of the art teaching hospital with the largest private finance initiative in the UK. Gastroenterology will be one of the largest clinical groups within this hospital.
Information for patients attending the GI Physiology Unit
Patient information guide on Oesophageal Manometry
Patient information guide on 24-hour Oesophageal pH monitoring
Patient information guide on colonic and anorectal physiology tests
Patient information guide on anorectal physiology tests
A specialist gastroenterology clinical research centre, The Wingate Clinical Trials Facility (WCTF) has emerged at the Wingate Institute of Neurogastroenterology, which is an internationally recognised centre of excellence. The WCTF has bespoke facilities and its staff have specialist expertise for performing gastroenterology-related clinical research. We run Phase II-IV commercial and non-commercial trials. In addition, we conduct clinical trials in gastroenterology which require highly specialised procedures and investigations, for which appropriately trained staff and equipment are provided. The team have excellent experience and the infrastructure is in place for undertaking such trials.
We strive to develop good relationships with our clients and in particular our patients through effective communication and transparency in all our activities. We have resources to design, conduct and disseminate clinical trials in a broad range of gastrointestinal diseases. Our principal investigators are leaders in their respective fields and are available to contribute to all aspects of clinical trials.
The Wingate Clinical Trials Facility provides clinical space, laboratory facilities, pharmacy and specialist staff dedicated to clinical research.
The facilities we offer are a comprehensive, accessible and efficient service, supporting researchers in all aspects of study conduct including:
Our values are central to how we operate, and we strive to achieve the highest possible standards by:
Barts Health NHS Trust
Blizard Institute, Centre for Neuroscience, Surgery and Trauma, QMUL
National Bowel Reseach Centre (NBRC)
Our current research programmes are wide-ranging and currently include:
The effect of food supplements on gut hormone levels – Funded by JP Moulton Charitable Trust
Obesity is often regarded as a lifestyle choice, whereas there is now good evidence to the contrary that once established, it is a chronic psychological disorder. Obesity is a major risk factor for many diseases ranging from Type II diabetes to cancer to dementia. Thus it is critical to expand alternative means of assisting people in maintaining a healthy weight. This area of research is important to a large proportion of the public, as 64% of adults were overweight or obese (67% of men and 61% of women) in England at the time of the last Health Survey.
The concept of our study is to redress the imbalance of hormones in the lower gut to a similar extent to that achieved by bypass surgery, but non-invasively. We have evidence to suggest that this can be achieved using natural dietary supplements that are already easily available and safe.
RECLAIM Study – Funded by MRC
Reclassifying constipation using magnetic resonance imaging combined with high resolution manometry (RECLAIM): a validation study and double-blind crossover trial.
Constipation is a common condition (14% of the population) which is poorly understood and for which treatment is often unsatisfactory. Many patients also experience pain whilst others do not and it is unclear why. It is believed that the pain arises from contractions of the colon. Some patients with constipation have weak colonic contraction but surprisingly, some, particularly those with a lot of pain, have strong contractions that are poorly coordinated. These patients all suffer from constipation but would in theory need very different treatments.
This study will take advantage of two new techniques, real-time magnetic resonance imaging (MRI), which will allow us to visualise the contractions of the colon, and high resolution colonic manometry (HRCM), which measures the power and direction of the contractions in much more detail than ever before.
Using these techniques, we hope to identify an individual’s pattern of contraction and subsequently predict which treatment would be best for them.
TRITON Study – Funded by NIHR Central Commissioning Faculty
Treatment of irritable bowel syndrome with diarrhoea (IBS-D) using titrated ondansetron (TRITON): a Phase III trial.
There is a current lack of effective treatment for IBS-D, which results in considerable cost to the NHS. This study aims to determine the effectiveness and safety of ondansetron, a generic, cost effective drug, in patients with symptoms of IBS-D including faecal urgency, looseness of stool, frequency of defaecation and abdominal discomfort.
The primary study objective is to find out whether 12 weeks of ondansetron increases the US Food and Drug Administration (FDA) defined responder rate (in relation to abnormal defaecation and abnormal pain) compared with placebo. We are also looking at what is the estimated treatment effect of ondansetron in relation to stool frequency, consistency, urgency of defecation, satisfactory relief of IBS symptoms, use of rescue medication and abdominal pain over 12 weeks’ treatment.
Wingate Clinical Trials Facility (WCTF)
Queen Mary University of London
26 Ashfield Street
London, E1 2AJ
Telephone: 020 7882 2645
Centre for Neuroscience, Surgery and Trauma
26 Ashfield Street