Blizard Institute - Barts and The London

Neurogastroenterology group

RECLAIM constipation study

We are looking for adults to take part in a study on the causes and treatment of constipation.

Find out more

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:

  1. Fundamental research on function of human sensorimotor cells and systems
  2. Understanding disease in humans
  3. New diagnostics, therapies and personalized medicine
  4. Health service delivery and dissemination

 

 

 

Pain Programme

Principal investigators: Qasim Aziz, Ashley Blackshaw, Madusha Peiris, Daniel SifrimCharles Knowles

 

  1. Fundamentalresearchonfunction of human sensorimotor cells and systems
    1. Mechanical and chemical mechanisms of peripheral stimulus detection in the gut
    2. Central processes
    3. Psycho-physiological interactions
  2. Understanding disease in humans
    1. Oesophageal sensitization
    2. Inflammatory Bowel Disease
    3. Chronic unexplained abdominal pain syndromes (inc. Irritable Bowel Syndrome)
    4. Chronic pelvic pain in women
    5. Post-operative pain
    6. Connective tissue disorders and pain
  3. New diagnostics, therapies and personalized medicine
    1. Cell-based – on individual sensory neurones
    2. Organ-based – interaction between neurones and other cell types
    3. RCT and concept studies
    4. Stratification studies
  4. Health service delivery and dissemination
    1. Community and self-help management strategies

Neurodegeneration and Ageing Programme

Colonic mesenteric sensory nerves labelled with CGRP antibody

Principal investigators: Gareth Sanger

  1. Fundamental research on human sensorimotor cells and systems
    1. Effects of ageing on colonic reflex movements and peristalsis
    2. Neuromuscular/secretory interactions with enteric bacteria
    3. Colorectal sensory pathway
  2. Understanding disease in humans
    1. Effects of ageing on neuromuscular activity, neurodegeneration and intestinal reflex functions
    2. Differential neuropharmacology in ageing – ‘pharmacochronetics’
    3. Exploration of rare diseases (including paediatric disorders, Chagas’ disease) – used also as exemplars for common complex diseases to show mechanism of disease and treatment
    4. Definition of neurodegenerative/ neuromuscular changes during chronic inflammation
    5. Secondary neuromuscular diseases including Parkinson’s
  3. New diagnostics, therapies and personalized medicine
    1. In vivo diagnostics: cost effective developments in less invasive methods of assessing colonic sensing and motility
    2. Development and trialling of age and disease-targeted drugs for chronic constipation and pseudo-obstruction, using models with proven translatable value
    3. Development and trialling of less invasive, extracorporeal neuromodulatory treatments for chronic constipation
    4. Development and trialling of pharmaconutrients / probiotics
    5. Neuroprotection or replacement in primary and secondary enteric neuropathies
  4. Health service delivery and dissemination
    1. Post trial effectiveness studies of interventional therapies e.g. neuromodulation
    2. Development of evidence-based NHS algorithms for management of common conditions e.g. constipation

Reflux Disease Programme

Principal Investigators:

  • Daniel Sifrim
  • Philip Woodland

 

  1. Fundamental research on function of human sensorimotor cells and systems
    1. Role of epithelial tight junctions and dilated intercellular spaces in oesophageal permeability
    2. Acid sensing molecules in the oesophageal epithelium
    3. Oesophagal sensory neurons and receptors
    4. Motilin receptors and oesophageal contractility
  2. Understanding disease in humans
    1. Epithelial permeability in reflux disease
    2. Oesophageal neuro-epithelial sensory mechanisms in patients unresponsive to acid suppression therapy
    3. Aetiology and role of hypomotility in reflux disease– sensory or motor?
  3. New diagnostics, therapies and personalized medicine
    1. Topical protection of the oesophageal mucosa
    2. New prokinetics
    3. Improvement in the valve function of the lower oesophageal sphincter and reduction of transient LOS relaxations
    4. LOS electrical stimulation
  4. Health service delivery and dissemination
    1. Guidelines for management of patients with reflux disease not responding to standard medical treatment.

Obesity Programme 

Principal Investigators: Madusha Peiris

 

 

  1. Fundamentalresearchonfunction of human sensorimotor cells and systems
    1. Nutrient receptor mechanisms in the gut epithelium
    2. Enteroendocrine communication between the gut and the CNS
  2. Understanding disease in humans
    1. Changes in enteroendocrine cell function in obesity
    2. Stress and neuroendocrine responses
  3. New diagnostics, therapies and personalized medicine
    1. Mechanism of action of bariatric surgery
    2. Cell-based – vagal afferent neurons and enteroendocrine cells
    3. Organ-based – enteroendocrine-vagal-brain communication
    4. Concept testing of anti-obesity treatments in obese patients

Connective Tissue and Extracellular Matrix Programme      

Principal Investigator: Qasim AzizAshley Blackshaw

 

  1. Fundamental research on human sensorimotor cells and systems
    1. How connective tissue components are distributed in the gastrointestinal tract and sensory nervous system
    2. Contribution of tenascins to gut function: sensation, motility, secretion, coordinated activity
  2. Understanding disease in humans
    1. Cross-correlating epidemiology of Joint Hypermobility Syndrome and Functional Gastrointestinal Disorders
    2. Changes in enteric tenascins in disease
  3. New diagnostics, therapies and personalized medicine
    1. Development and trialling of treatments suited to altered motility and sensation in Joint Hypermobility Syndrome
  4. Health service delivery and dissemination
    1. Development of evidence-based NHS algorithms for management of common co-morbidities e.g. constipation, upper GI symptoms

 

 

Teaching

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.

Clinical Training

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.

Research Training

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 neurogastro@qmul.ac.uk to discuss possibilities for future research.

Education

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.

Public engagement

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).

Clinical services

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

Neurogastroenterology Group staff list

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.

Our mission

  • To provide a high quality environment and governance structure for gastroenterology-specific clinical trials with emphasis on data integrity, patient safety, quality and ethical conduct.
  • We will continue as  a centre of excellence for gastroenterology research and make a positive impact on patients care and the development of life-saving and life-enhancing treatments. 

The people

WCT Facilities

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:

  • patient/volunteer recruitment
  • support with informed consent process
  • study co-ordination and arrangement of appointments
  • subjects enrolment procedures 
  • data collection, data entry and dealing with data queries
  • recording and reporting of adverse events 
  • appropriate handling and preparation of research samples
  • routinely provide, but not exclusively, the following: Endoscopy, Colonoscopy, Biopsy, ECG, GI physiology. 

Our Values

Our values are central to how we operate, and we strive to achieve the highest possible standards by:

  • building mutual respect, honesty and fairness
  • working in a collaborative way with other specialties
  • continually developing our knowledge and skills
  • building lasting relationships by delivering high levels of service
  • delivering an outstanding performance
  • admitting mistakes and learning from them. 

Links and collaborations

Barts Health NHS Trust

Blizard Institute, Centre for Neuroscience, Surgery and Trauma, QMUL

National Bowel Reseach Centre (NBRC)

Current research programmes

Our current research programmes are wide-ranging and currently include:

Some current active trials

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.

(https://files.digital.nhs.uk/5B/B1297D/HSE%20report%20summary.pdf 2017).

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.

Rationale:

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. 

Contact us

Wingate Clinical Trials Facility (WCTF)
Blizard Institute
Queen Mary University of London
26 Ashfield Street
London, E1 2AJ 

Telephone: 020 7882 2645

Email: wingateCTF@qmul.ac.uk

Prof Qasim Aziz
Deputy Centre Lead, Director of The Wingate Institute for Neurogastroenterology

 

Ms Jyoti Salhan
Centre Manager

 

Sam Pimm
PA to Prof Qasim Aziz
s.j.pimm@qmul.ac.uk 

 

Please note that Sam Pimm should only be contacted for academic matters. NHS patient queries should be directed to:

Address

Neurogastroenterology Group
Centre for Neuroscience, Surgery and Trauma
Blizard Institute
26 Ashfield Street
Whitechapel
London
E1 2AJ

neurogastro@qmul.ac.uk