Why the UK is a good place to deliver neurogastroenterology and clinical nutrition research
The NIHR Clinical Research Network (CRN) provides researchers with the practical support they need to make research happen in the NHS and the wider health and social care environment. As well as providing research delivery staff, we also bring together communities of clinical practice to provide national networks of research expertise. The Gastroenterology Specialty is one of 30 such communities and is made up of leading research-interested clinicians and practitioners at both national and local levels. Our job is to ensure that the gastroenterology studies we support are delivered to time and target.
Neurogastroenterology is the subspecialty dealing with gut disorders of motility and sensation, including, but not limited to: oesophageal reflux, gastroparesis, chronic vomiting, irritable bowel syndrome (IBS), non-ulcer (functional) dyspepsia, bile acid diarrhoea and constipation. The field of gastrointestinal (GI) nutrition covers coeliac disease, food allergies/intolerances, obesity and dietary management. Studies of the gut microbiome are also included in this field. We also welcome opportunities to study medical devices in the diagnosis and management of disorders of gut function.
Professor Tariq Iqbal is the NIHR Clinical Research Network’s (CRN) National Specialty Lead for the Gastroenterology Specialty. Dr Fraser Cummings is our dedicated National Industry Lead for commercial studies, his role is to provide strategic direction as well as an operational link between the life sciences industry, the CRN and researchers.
Our Gastroenterology Specialty has strong representation and support from the British Society of Gastroenterology (BSG) Research Committee, led by Professor Shaji Sebastian, and the BSG Food and Function Clinical Research Group, established by Dr Helen Steed. The current membership of the Food and Function clinical research group is available on the BSG website.
Food and function was highlighted as a theme in the BSG Clinical Research Strategy published in 2018. Linking to the BSG in this way ensures that we aware of neurogastroenterology and nutrition studies in the pipeline and enables us to plan and allocate support upcoming research. Our aim is to ensure that all neurogastroenterology and nutrition studies on the CRN Portfolio receive the right level of support to achieve success.
Access to patients
The Gastroenterology Specialty helps researchers to access NHS patients. In 2020/21 we helped to recruit over 19,000 participants into gastroenterology studies across England. Patients with neurogastroenterological problems such as IBS are the largest group of patients seen by gastroenterologists and are one of the most common GI problems seen in primary care. We can help you to access this and other patient groups in a variety of health and care settings.
Part of our research recruitment capability lies in our ability to access the ContactME_IBS registry; a national registry of patients with IBS who have consented to be contacted about participating in research. This registry is proving highly successful as a recruitment tool for IBS trials. We also have close working relationships with primary care providers, which further boosts our capability to recruit from the community.
In addition to general gastroenterology practice, we have connections with a network of specialist units which support research into conditions requiring advanced investigations. This includes, but is not limited to: oesophageal and anorectal physiology gastric emptying studies, SeHCAT testing, SmartPill and functional MRI scanning.
Over recent years we have achieved significant improvements in delivering studies to time and target. This has been driven by our continuous improvement culture, specifically around providing more accurate feasibility assessments at sites and more proactive monitoring of performance. Recruitment into neurogastroenterology and nutrition studies has increased year on year since 2015. The number of studies, and number of NHS trusts participating in these studies, has also increased year on year. This demonstrates our ability to expand and deliver these studies across England.
We have an excellent track record in delivering commercial GI research funded by the life sciences industry. Recent examples include:
• Enterosgel® in the treatment of IBS with diarrhoea.
• Large quality of life studies of patients living on parenteral nutrition or the role of diet in patients with Inflammatory Bowel Disease.
• Linaclotide Phase IV study that was published in 2018 in the journal Therapeutic Advances in Gastroenterology which was delivered by our neurogastroenterology community.
• Faecal bile acid study (in the field of bile acid diarrhoea) - currently recruiting ahead of time and target.
We also work proactively to identify where more research is required. For example, we have a strategy in place to develop a number of research projects in Coeliac disease. This strategy was developed in response to the recent Coeliac UK priority setting partnership (a collaboration with the NIHR-funded James Lind Alliance) which published the top ten research priorities in the field of Coeliac disease.
Our collaborative culture in the UK is one of our strengths. We have many close working relationships with charities and affiliated patient support groups including the Bowel Research Advisory Group (BRAG), Guts UK, Bowel and Cancer Research, Coeliac UK and PINNT (Patients on Intravenous and Naso-gastric Nutritional Therapy).
We also work closely with the Gastroenterology Specialty Group and the BSG, and we regularly contribute to the BSG Research Strategy.
In 2021, we are launching a priority setting partnership for Irritable Bowel Syndrome in partnership with the BSG Food and Function group and our sister charity, Guts UK.