Our proposed research will use an established multi-disciplinary group called ENiGMA (Evaluating goaldirected management of fistulating perianal Crohn’s disease), made up of gastroenterologists, colorectal surgeons, specialist nurses and patients from 5 major teaching hospitals to establish a database of information about patients with fistulating perianal Crohn’s and to create a bank of tissue, faecal and blood samples to help improve understanding of the causes and potential ways of intervening to heal perianal Crohn’s fistulae.
These are the research projects that BDRF have funded.
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How do different surgeons decide when to avoid or give a stoma, and when this should be permanent or not? Gaining a better understanding of the different factors involved in this decision to begin standardising practice nationally
There has been very little work assessing how surgeons make decisions on making a stoma for a patient and the work that has been done has focused on influencing patient factors (e.g. poor health, smoker). This unique work will provide insight into what decision-making tools each surgeon uses to make such an important and life-changing decision.
Rectal prolapse is a distressing condition where the bowel lining prolapses outside the anal canal. Only surgery can cure the problem and surgeons have invented many operations to do this. However, no-one knows which is best. A new operation called a laparoscopic ventral mesh rectopexy seems to be the best but surgeons are worried that the results are not as good as we think and that it may be dangerous if done wrong.
What is the best way to treat patients facing multiple surgeries to remove cancers that have spread beyond the bowel?
Bowel cancer may sometimes spread to other organs in the body, such as the liver or lungs. While chemotherapy may help prolong survival for these patients, the only possibility of long-term cure is if the cancer can be removed surgically. For many patients, this means facing surgery for the primary cancer in the bowel, surgery to remove part of the liver and also chemotherapy. We do not yet know what is the best way to treat these patients.
A study to find out the best methods for assessing and treating anal Crohn’s fistulae, building a consensus on optimum care among clinicians.
An anal fistula is very challenging to treat. It is associated with lower quality of life and problems such as incontinence. Treatment uses a combination of medications and operations. We would like to undertake a clinical trial to improve management, but think that we need more information before we can do this.
Can cell analysis predict the effectiveness of chemoradiotherapy in rectal cancer, enabling clinicians to tailor treatment plans to each individual patient?
We hope that it may be possible from this study to identify mitochondrial genetic markers which could predict how patients will respond to chemoradiotherapy and allow us to tailor their treatment accordingly.
What is the best method of predicting response and preventing recurrence in screen-detected polyp cancers?
Screening for bowel cancer saves lives partly by detecting cancers at an early stage. The very earliest cancers occur as microscopic tumours in polyps removed during colonoscopy (polyp cancer). These were rare before screening but make up at least 10% of screen-detected cancers. We have only limited information on how best to manage patients with polyp cancer. There is urgent need to identify which individuals require surgical removal of colon and which can be managed conservatively. We propose to use the Scottish screening patients with polyp cancer to answer this question
There is some evidence that removing the bowel tumour (primary tumour) in patients with Stage IV disease is associated with better survival. We speculate surgery is beneficial, however, we do not know when the best time to perform the surgery is. Previous studies have attempted to answer this important clinical question however have failed due to a variety of reasons. We believe this is an important research question which needs a step-wise approach to identify the best way to try and answer this question.
In the UK more collaborative and standardised research is required rather than the scattered individual projects that currently exist. This project aims to facilitate this by developing a national sampling strategy for rectal cancer along with centralised storage of tissue and data which can be accessed by research teams.
We believe that the nutritional needs of patients with a blocked bowel may be overlooked, and not properly assessed or managed. This may result in longer hospital stays or increased rates of complications such as infections or even death.