The doctors leading the way in gut conditions

WhILe inflammat o r y bowel disease may not kill people, it is an ‘underrated illness’ that can ruin lives, says John Abercrombie, a colorectal surgeon at Nottingham City hospital.

Inflammatory bowel disease (IBD) is an umbrella term that includes Crohn’s disease and ulcerative colitis — they are forms of autoimmune disease where the digestive tract is attacked by the immune system, causing progressive damage.

If it’s not controlled adequately, the symptoms — diarrhoea, agonising abdominal cramps, exhaustion and weight loss — can be crippling. ‘ In severe cases people talk about their life being “on hold”, not being able to travel, socialise or work. They feel incredibly isolated and there is a huge amount of shame,’ adds Dr Gareth Parkes, a consultant gastroenterologist at the Royal London hospital and BMI The London Independent hospital.

Up to 350,000 people in the UK are affected — double the number 30 years ago. One explanation is changes in the gut microbiome (bacteria in the gut) may play in the onset of symptoms, explains Dr Naila Arebi, a consultant gastroenterologist at St Mark’s hospital in London.

‘The changes may be caused by any number of environmental factors, including greater use of antibiotics,’ says Dr Arebi. Diet may play a role.

essentially the gut loses its ability to distinguish friendly bacteria that aid digestion and damaging bacteria. ‘ So it starts treating healthy bacteria as an infection it needs to attack,’ says Professor Simon Travis, a gastroenterologist at John Radcliffe hospital in Oxford. ‘This leads to uncontrolled inflammation.’

With ulcerative colitis this inflammation is limited to the inner lining of the colon and rectum. With Crohn’s it can affect the full thickness of gut wall anywhere from the mouth to the bottom, causing narrowing and blockages; these pave the way for abscesses — pus-filled pockets — that burrow through the gut wall, creating tunnels ( fistulae) that break into surrounding structures such as the bladder or even skin.

IBD patients are first treated by gastroenterologists who try to keep disease at bay with drugs, but 70 per cent of Crohn’s patients and 25 per cent of those with ulcerative colitis will need surgery.

Surgery for Crohn’s will often mean cutting out a diseased part of the gut and re-joining the ends — further surgery at the same site is likely. The resulting shortened gut can also affect the patient’s nutritional status. Surgery for ulcerative colitis may entail removing the colon and a colostomy bag.

IBD patients need a compassionate gastroenterologist with an extraordinary mix of skills — someone who can empathise with the embarrassment and social isolation many patients experience, who’s able to tailor the latest science to their needs while negotiating the tightrope between drug treatments and surgery — and getting the timing perfect for each.

To identify the best IBD experts we canvassed the view of around 30 gastroenterologists and colorectal surgeons from around the country. here, we reveal their choices . . .

GUT EXPERTS RATED BY THEIR PEERS PETER IRVING

Guy’s & St Thomas’ Hospitals in London WHAT THEY SAY ABOUT

HIM: ‘A leading and very experienced IBD specialist who is up there as one of the top guys — I sent my sister to him,’ one reveals.

‘he is focused on optimising the best medical therapies for his patients and is a world leader in therapeutic drug monitoring where you monitor the dose and how this is metabolised by patients and adjust the dose accordingly.

‘he is the quintessential gastroenterologist — very caring and committed, he has the most understanding manner and empathises with the problems patients face and patients trust him implicitly for it,’ says another.

PRIVATE: hCA UK London Digestive Centre, The Princess Grace hospital in London.

ALASTAIR WINDSOR

University College Hospital in London WHAT THEY SAY ABOUT

HIM: ‘ he is the full package, an exceptionally gifted surgeon and a clear leader in a very complicated, niche area of IBD surgery,’ according to one of his peers.

‘his specialty area is abdominal catastrophes in Crohn’s — when things go spectacularly wrong sometimes as a result of disease but also as a result of complications

from previous surgery. You can sometimes see the gut through a hole in the abdomen with these patients — he salvages them.

‘They will be on intravenous feeding for months but he will reconstruct the bowel and abdominal wall together with a plastic surgeon — demanding six or seven-hour procedures.’

‘He is thoughtful and careful and has the incredible quality of being a human being first and foremost — patients love him,’ says another.

PRIVATE: The London Clinic, King Edward VII’s Hospital Sister Agnes, Princess Grace Hospital, both in London.

JAMES LINDSAY

The Royal London Hospital

WHAT THEY SAY ABOUT HIM: ‘A star in the field of IBD — a very reliable, highly sympathetic, committed, efficient and caring physician,’ says one of his peers.

‘Not all high-flying academics make the best physicians — but he combines both. He’s a member of the governing body of the European Crohn’s and Colitis Organisation, one of only four UK gastroenterologists elected as a member of the IOIBD, the International Organisation for the Study of Inflammatory Bowel Disease. He is also the lead investigator of a national trial on stem cell transplantation for Crohn’s disease.’

PRIVATE: HCA UK London Digestive Centre, Princess Grace Hospital in London.

PROFESSOR SIMON TRAVIS

John Radcliffe Hospital in Oxford WHAT THEY SAY

ABOUT HIM: ‘A big mover and shaker internationally in IBD therapy, he’s on the cutting edge of the latest advances in treatments and will make a good judgment about when he should deploy them,’ says one of his peers. ‘An elected member of the IOIBD, he has authored 230 papers on IBD and has been chief investigator on eight global clinical trials.’

Another says: ‘A brilliant communicator, he runs a very patient-orientated practice.’

PRIVATE: Nuffield Health Oxford, The Manor Hospital in Oxford.

AILSA HART

St. Mark’s Hospital in Harrow WHAT THEY SAY ABOUT HER: ‘An outstanding physician who is warm and very passionate about her work in IBD. She has such depth of knowledge and is right at the forefront in developing new treatments as a leading researcher,’ says one of her peers.

‘She is director of St. Mark’s Hospital Inflammatory Bowel Disease Research unit, and has a particular interest in the microbes that live in the gut and play a key role in nutrition and immunity,’ according to another. ‘Patients love her.’

PRIVATE: BMI The Clementine Churchill Hospital, HCA UK London Digestive Centre, The Wellington Hospital, The Platinum Medical Centre, all in London.

MILES PARKES

Addenbrooke’s Hospital in Cambridge WHAT THEY SAY ABOUT HIM: ‘A world leader in genetic causes of IBD — he wants to understand what drives the severity of the illness and how we can personalise medicine based on better understanding of the root cause,’ says one of his peers. ‘He is open-minded, listens to his patients, cares about them and very much wants to take their viewpoint into account. He is also an excellent communicator, highly knowledgeable and gets on well with his team.’

PRIVATE: Spire Cambridge Lea Hospital, Nuffield Health Cambridge Hospital.

PROFESSOR JACK SATSANGI

Western General Hospital in Edinburgh WHAT THEY SAY

ABOUT HIM: ‘He’s done sterling work on understanding the risk factor genes for Crohn’s and how the environment affects the genes in IBD,’ explains one of his peers.

‘He’s also gentle, thoughtful and compassionate, the nicest man you could wish to meet and will go to the ends of the earth for his patients.’

PRIVATE: Professor Satsangi does not work privately.

PROFESSOR CHRIS PROBERT

Royal Liverpool University Hospital WHAT THEY SAY ABOUT HIM: ‘A personable and down-to- earth man who has built an excellent team and has immense academic knowledge — his research has changed the management of ulcerative colitis,’ says one.

‘He collaborated with French researchers on enema therapy for ulcerative colitis and this is now the standard of care for mild to moderate disease.

‘He was involved in the early work behind giving infliximab to patients with moderate to severe disease — this has become a vital rescue treatment for patients.

‘ Many have been spared repeated steroid courses or surgery to remove their colon as a result.’

PRIVATE: Professor Probert does not work privately.

BRUCE GEORGE

Churchill Hospital in Oxford WHAT THEY SAY

ABOUT HIM: ‘An excellent “plumber” with a lot of energy,’ says one of his peers.

‘Nothing is too much for him. He will sort out patients who have had an abdominal disaster — say leaks between the bowel and skin — and patients who don’t have enough bowel to provide their nutrition.’

‘ He has extremely good judgment and his main interest is reducing the complications related to surgery,’ says another.

PRIVATE: Nuffield Health The Manor Hospital, Foscote Hospital in Banbury.

JOHN ABERCROMBIE

Nottingham City Hospital WHAT THEY SAY

ABOUT HIM: ‘A wonderful surgeon who’s quite humble,’ says one of his peers. ‘He gives a considered opinion and if he thinks surgery will do more harm than good, says so. He’s also a surgeon with green fingers — he has this natural ability to make surgery work when he does think it is the right option and he can be relied upon to get the best possible outcome.’

‘He’s a firm advocate of driving up standards in the health service; he is the clinical lead for general surgery in the NHS’s Getting It Right First Time programme, set up to boost clinical standards and efficiency in the health service,’ reveals another.

PRIVATE: Mr Abercrombie does not work privately.

PROFESSOR PETER SAGAR

Leeds General Infirmary, St James’s University Hospital in Leeds

WHAT THEY SAY ABOUT HIM: ‘A remarkable man who works tirelessly for his patients,’ says one. ‘ An expert on IBD and bowel cancer surgery and a very clear thinker. He’s a very fine presenter of information and was one of the trailblazers for the take up of keyhole surgery for IBD in this country — although this only suits the mild end of the IBD spectrum. ‘A very good surgeon.’ PRIVATE: Nuffield Health Leeds Hospital.

JOHN MANSFIELD

Royal Victoria Infirmary in Newcastle WHAT THEY SAY

ABOUT HIM: ‘ Very thoughtful, gentle and has done a lot as part of the UK/IBD Genetics Consortium which aims to pinpoint the genes which dispose patients to IBD and to study the side- effects of treatment.

‘He’s no man’s fool and will speak his mind — and if he thinks something being discussed at a meeting is drug company spin, he’ll say so.’

PRIVATE: Dr Mansfield does not work privately.

BARNEY HAWTHORNE

University Hospital of Wales in Cardiff WHAT THEY SAY

ABOUT HIM: ‘A lovely man, very clued up, sensible and a superb communicator and he’s someone who has a lot of time for his patients,’ according to one of his peers.

‘He is widely acknowledged as Wales’s leading IBD specialist but his forte is clinical work.’

‘He’s very critical of many of the drug trials and justifiably so,’ says another.

‘Some drug companies will try to put positive spin on therapies that have performed badly in trials — and he’ll call it out if he feels it is warranted.’

PRIVATE: Spire Cardiff Hospital.