Gastroenterology research

About our research

Our integrated team of gastroenterology researchers, nurses and clinicians are at the forefront of gastroenterology research in the UK.

Research into inflammatory bowel disease (IBD) is a major strength across King’s Health Partners (KHP), bringing together several independently successful research groups: immunology, genetics, dieticians, psychiatry and clinical IBD.

We have an international reputation as leaders and pioneers of optimised immunosuppression trials looking into IBD using pharmacogenetics (the study of inherited genetic differences in drug metabolic pathways which can affect individual responses to drugs).

Researchers at Guy's and St Thomas' have also conducted research looking into new drug targets – which has shaped IBD practice across the globe (Taylor Nat Rev Gastroenterol Hepatol 2011, Heap Nature Genetics 2014). Together we are developing precision medicine approaches to improve patient care through several research trials.

If attending one of the outpatient clinics, please be aware that you may be invited to take part in one of our current studies. If you would like more information on any of the studies, please email us at gastroenterologyresearch@gstt.nhs.uk.

The Biomedical Research Centre patient and public involvement advisory group (PPIAG) develops methods of engagement with the local population. They also provide a patient/public perspective on a variety of research practices and approaches.

Current research studies

Click on the headings below to find out more about each study and see if you might be eligible to take part and help us with our research.

Please note that our research team will only recruit participants currently registered with us. If you are a patient elsewhere, please consult with your gastroenterologist, who may be able to refer you to us.

If you would like more information on any of the studies, please email us at gastroenterologyresearch@gstt.nhs.uk.

  • ASTIClite

    The ASTIClite trial aims to assess whether stem cell transplantation, with a low intensity treatment regimen, can reduce the symptoms and activity of Crohn’s disease and enhance quality of life, compared to current standard care. The trial will also assess the safety of the procedure, explore the mechanisms involved in immune reconstitution and whether patients who do experience recurrent disease after the stem cell transplant will respond to treatments which had not worked previously. Finally, we will assess the long-term safety and efficacy in patients undergoing stem cell transplantation over a minimum of a further four years.

  • Defining immune pathways

    A number of chronic conditions have been associated with gut inflammation, including coeliac, inflammatory bowel diseases (IBD) (ulcerative colitis, Crohn’s disease), metabolic disorders (obesity, diabetes), chronic liver conditions (including autoimmune diseases and non-alcoholic fatty liver disease) and graft versus host disease (GvHD, a complication of bone marrow transplantation).

    Despite the recent advantages in the understanding of genetics, the mechanisms behind gut damage remain unexplained. This limited understanding is reflected in the limited treatment options available for these conditions.

    The development of innovative techniques in experimental immunology have provided researchers with the opportunity to understand the components of the inflammatory response. With this study, we hope to use these techniques to define the different pathways driving gut inflammation.

  • FAVOUR

    Vedolizumab is a new and effective treatment for patients suffering from ulcerative colitis (UC). However, some patients treated with Vedolizumab do not experience a significant benefit and even those who benefit initially may find that the effect of the medicine reduces over time.

    The purpose of this study is to identify whether these different responses to treatment are linked to levels of Vedolizumab found in the blood of patients treated with the drug. We predict that some of the drug is lost from the body in faeces (stool) and that this results in a fall in blood levels and makes it less likely to have a beneficial effect. We hope that demonstrating this potential route of loss will allow healthcare professionals to account for it and tailor their treatment to the individual patient, giving it a better chance of succeeding.

  • GO-LEVEL

    Golimumab is a new treatment option for patients suffering from ulcerative colitis (UC). It has been proven effective in controlling the condition in large-scale, high quality clinical trials. However, a large proportion of patients will still fail to gain a meaningful benefit from the treatment. The reasons underlying this poor response to Golimumab are not yet entirely understood.

    It has been suggested that the levels of Golimumab in the blood of patients who respond less well to treatment are lower than those who have a good response. We have designed a study to investigate this suggestion and, if proved correct, try to identify a level of drug in the blood that clinicians could aim for as a target to give their patients the best chance of having a good outcome when being treated with Golimumab. This will involve observing how well patients respond to the treatment, whilst also measuring levels of the drug in their blood at certain points. As well as seeing how well symptoms are controlled, we will also measure how well the inflammation is controlled using blood and stool tests.

  • Gut bacteria in colorectal cancer

    The human gut is lined with a thick layer of bacteria called the gut microbiome. Changes in the microbiome have been linked to several diseases including cancer. This study will look at the effects of some of the toxins produced by gut bacteria on colorectal cancer development.

    Patients will undergo a colonoscopy where samples from the bowel lining will be obtained. Samples will be collected from patients:

    • with a new diagnosis of colon cancer
    • with large non-cancerous growths known as polyps
    • who have had colon cancer removed and are undergoing follow up colonoscopy
      With chronic inflammatory conditions of the bowel who are undergoing routine check-up colonoscopy
    • with a healthy bowel used as 'controls'
    • blood and stool samples will also be collected from selected participants. The sample collection will be undertaken in the endoscopy department at Guy's and St Thomas' hospitals.
  • IBD BioResource

    Recent years have seen major advances in understanding the causes of Crohn’s disease and ulcerative colitis. This particularly relates to their genetic basis, and how gene variants affect the immune system of people who develop IBD.

    The key challenge now is to translate this new knowledge into new treatments, and use it as a platform to drive towards a cure for IBD.

    This is where the UK IBD BioResource comes in – allowing scientists and researchers to access groups of patients with Crohn’s or colitis who have uniform genetic make-up or clinical features, so that they can ask very focused questions relating to disease mechanisms and potential new treatments.

  • Immune cells in IBD

    This study is interested in looking at immune cells in the blood and bowel wall of people with IBD and to compare these with people without IBD. We hope that this will give us clues as to the cause of IBD. They are particularly interested in looking at a type of cell called “regulatory T cells”, or “Tregs”.  They will carefully analyse Tregs in people with IBD and people without IBD. They would like to determine if it might be possible to use Tregs as a potential treatment for IBD in the future.

  • PRED 4

    This is a study for patients who have inflammatory bowel disease (IBD), for example Crohn's disease or ulcerative colitis, who have taken any of the following medicines and experienced any of the accompanying side effects. We are asking all of these patients whether they would be happy to answer some questions and give a blood sample.

    1. Azathioprine or Mercaptopurine – the side effects that we are studying are joint pain, muscle pain, fever, problems with the liver, problems with the white blood cells inflamed pancreas.

    2. Infliximab or Adalimumab – the side effect that we are studying is a problem with the brain and spinal cord (demyelination).

    3. Sulfasalazine – the side effect that we are studying is a problem with the white blood cells (neutropenia).

    4. Proton pump inhibitors (for example Omeprazole and Lansoprazole) – the side effect that we are studying is a problem with the kidneys (interstitial nephritis).

  • PREdiCCt

    The inflammatory bowel diseases, Crohn’s disease and ulcerative colitis, affect about 1 in 200 (mostly young) people in the UK. They cause serious ill health, making sufferers quite weak, typically giving them abdominal pain, bloody diarrhoea, nausea and lethargy. This means they don’t do so well at school, are more socially isolated and can have high levels of anxiety and depression. Treatments have toxic side effects and don’t really work that well so many patients understandably reject them.

    In recent years we’ve got better at understanding the underlying biology of IBD. We think that, although it’s normal for the gut’s immune system to produce mucus, people with certain genes are prone to IBD and produce too much. However, we are still far away from knowing just what causes someone to develop IBD. The course of IBD varies and can’t be predicted. It isn’t always active, but when it ‘flares’ it frequently leads to permanent bowel damage. Treatment does calm it down (put it in remission). We don’t have nearly enough data just now to predict if a patient’s IBD will be mild or severe. Also, we don’t know what causes IBD to flare again.

    Launched in the UK the focus of the study is towards understanding how diet, lifestyle and the bacteria in your gut influence flare and recovery in Crohn’s disease and ulcerative colitis. To achieve this we are looking to recruit 3,100 people in remission from Crohns or Colitis (illness under control). We plan to follow the disease course of these individuals over two years whilst collecting information on the food they eat, their lifestyle and their gut bacteria. Accordingly, it may be possible to find a link between these factors and the severity of each participant’s symptom flares.

  • PROFILE

    Crohn’s disease is a type of inflammatory bowel disease (IBD) that can affect any part of the intestine. The severity of Crohn’s disease varies a lot between different people, and this means that what might be the best treatment for one person may not be appropriate for someone else. This study will see whether a simple blood test (‘biomarker’) can improve Crohn’s disease outcomes and reduce the number of flares experienced by enabling delivery of ‘personalised therapy’ (that is, treatment tailored to the individual person based on their predicted disease course and severity). All patients enrolled receive established treatments (there are no new drug therapies being trialled – rather, it is the new blood ‘biomarker’ that is being tested). The aim of this study is to see if the biomarker allows us to choose the right strategy for the right patient at diagnosis, and so improve short-term and long-term outcomes.

  • TRIBUTE

    This trial is expected to look at a new type of treatment for Crohn’s disease (CD), called regulatory T-cells (Tregs) immunotherapy.

    Regulatory T-cells are produced by the immune system. These cells prevent auto-immune diseases by suppressing the over-active response that the immune system mounts against the body in these diseases. It is thought that in patients with active CD, other immune cells in the gut are resistant to the normal controlling action of Tregs.

    Treg immunotherapy is unique to each patient. In this type of treatment, white blood cells are extracted from patients’ blood. These cells are then used to create the Treg immunotherapy. They are then grown in an accredited laboratory and increase in number. The treatment is then frozen until it is given to the patient.

    This trial is not yet recruiting patients. If you are interested in taking part please speak to your Gastroenterologist. For further information please contact gastroenterologyresearch@gstt.nhs.uk.

Previous studies

Read about past studies. Please note we are no longer recruiting participants for these trials.

  • Faecal Incontinence iNtervention Study (FINS)

    We asked a selection of our patients who have inflammatory bowel disease (IBD), for example Crohn's disease or ulcerative colitis, whether they experience faecal incontinence (uncontrollable passing of poo) via a quick two-page questionnaire completed with a research nurse or sent in the post.

    For selected participants, a self-management tool and advice from IBD clinical nurse specialists was offered to them, aiming to improve their experience with faecal incontinence.

    For more information, please visit the ClinicalTrials.gov website  or contact the principal investigator of the study Julie Duncan at julie.duncan@gstt.nhs.uk.

     

  • Food-related quality of life in inflammatory bowel disease

    Food is an important part of people's lives. It can be a source of pleasure, a method of coping and an important means of social interaction. Previous research has shown that these experiences can be different in people with inflammatory bowel disease (IBD), as many feel excluded from social interactions involving eating and drinking, some limit the amount of food consumed, and some feel stressed and anxious due to uncertainty of the impact of eating on bowel function. However, we do not know how many people are affected by these problems, what the most common problems are, or why and when they occur. More importantly, we do not know how to help people affected by these problems.

    Aims of this two phase study

    • Phase 1 – measure the extent and type of problems with food-related quality of life in people with IBD. A national survey will be undertaken with 1,525 people with IBD. They will be asked to complete the food-related questionnaires. This will allow us to calculate how many people experience food-related problems, what the most common problems are, and what affects their severity.
    • Phase 2 – involve people with IBD in developing tools to help others address these problems. People with IBD who have experienced problems of food-related quality of life and have successfully addressed them will be invited to take part. We will start by understanding the potential approaches to addressing the problems from the perspective of patients and health professionals. Then joint patient/health professional meetings will take place with the use of film/audio ‘patient stories’ so that all involved can understand what the issues are and how best to resolve them. The tools to help address food-related quality of life in IBD will be developed in a series of up to five meetings.

    For more information, please email gastroenterologyresearch@gstt.nhs.uk.

    We will approach eligible patients to take part in this study.

  • The Flora colonoscopy twin study: genetic transmission of components of the human microbiome

    The human gut is lined with a thick layer of bacteria called the gut microbiome. Most of the bacteria in the human microbiome have benefits for the body, including protection from pathogens and enhanced nutrition. However, there is evidence that changes in the microbiome are associated with some chronic illnesses involving the gut. There may also be links between people’s genetics and their microbiome, suggesting that the microbiome may have a heritable component.

    This study aims to look at the differences in the structure of the microbiome and to understand the biological processes that link the microbiome to its host. We are already doing this using microbiome samples from the faeces, skin, nose and mouth in the cohort participating in the flora twin study. We intend to extend this work in a subset of this cohort (100 twin pairs) by looking at the genetic composition of the microbiome in samples from several sites inside the gut taken by colonoscopy.

    For more information, please email gastroenterologyresearch@gstt.nhs.uk.

    We will approach eligible patients to take part in this study.

  • Orofacial granulomatosis

    In some individuals Crohn’s disease affects the mouth causing cracked swollen lips and painful oral ulceration. This rare form is sometimes referred to as orofacial granulomatosis or OFG.

    There are two types of the disease; OFG that affects patients who also have Crohn’s, and OFG that affects patients who don’t have Crohn’s.

    We are recruiting volunteers with both types of OFG to investigate its genetic causes to see if they overlap with the genetic risk factors for the intestinal form of Crohn’s disease. We are also exploring whether microbial changes in the saliva of OFG patients are associated with disease or the onset of intestinal Crohn’s.

    For more information, please email gastroenterologyresearch@gstt.nhs.uk.

    We will approach eligible patients to take part in this study in clinics.

  • Quality of Life Tool for IBD

    This study explored the acceptability of an intervention manual to patients. The cognitive-behavioural therapy (CBT) inspired manual contained several chapters. Each chapter addressed a different topic with information, guidance in setting goals for behaviour change and accompanying tasks to aid implementation.

  • Personalised Anti-TNF Therapy in Crohn’s disease (PANTS)

    We asked a selection of our patients who have inflammatory bowel disease (IBD), for example Crohn's disease or ulcerative colitis, taking the medicines infliximab or adalimumab, whether they would like to take part in a long-term study looking at how well they respond to these medicines. Participation required meeting periodically with a research nurse and answering questions and giving blood and stool samples.

    Find out more information about the PANTS project.

  • SPARE

    The SPARE study is a randomised controlled trial comparing combination therapy (the use of multiple drugs) to monotherapy (the use of a single drug only) in Crohn’s disease patients. The aim of this study is to show that infliximab therapy (with or without other drugs such as mercaptopurine, azathioprine, methotrexate) is superior to just those drugs alone to maintain sustained steroid-free remission over two years.

    The main end point of the study is clinical relapse rate at two years. The study is sponsored by NHS Lothian and hopes to recruit 300 patients overall.

    For more information, please email gastroenterologyresearch@gstt.nhs.uk.

    We will approach eligible patients to take part in this study.

  • The UK Vedolizumab real life experience study in inflammatory bowel disease (VEST)

    Vedolizumab is licensed for use in the management of ulcerative colitis (UC) and Crohn's disease (CD).

    This study aimed to capture the experience of this therapy across the UK. Patients completed a number of simple questionnaires whilst having their Vedolizumab infusions during their first year of treatment. Teams recorded data including details of the patient's IBD such as characterisation of their disease, medications, previous history and blood tests taken as part of the patient’s routine clinical data.

    For more information, please email gastroenterologyresearch@gstt.nhs.uk.

Researchers

  • Dr Bu’ Hayee, clinical lead for gastroenterology, King's College
  • Dr Peter Irving, consultant gastroenterologist, Guy's and St Thomas' Hospital
  • Dr Natalie Prescott, Wellcome Trust University award research fellow, medical and molecular genetics department, King's College London
  • Dr Tony Marinaki, faculty of life sciences and medicine department
  • Professor Christopher Mathew, head of complex disease genetics group, genetics and molecular medicine department, King's College London
  • Dr Nick Powell, Wellcome Trust intermediate clinical fellow, King's College London, honorary consultant in gastroenterology, Guy's and St Thomas' Hospital
  • Professor Jeremy Sanderson, consultant gastroenterologist, clinical director, gastrointestinal medicine and surgery, Guy's and St Thomas' Hospital
  • Professor Jo Spencer, professor of experimental medicine, King's College London

External information

Useful links to other sites that may be of interest.

Patient services

Take part in a clinical trial

Find out how you can take part in a clinical trial at Guy’s and St Thomas’ and what is involved.