Robin Spiller

Robin Spiller
University of Nottingham | Notts · Nottingham Digestive Diseases Centre

MB BChir MSc MD Cantab FRCP

About

608
Publications
66,411
Reads
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32,862
Citations
Citations since 2017
99 Research Items
12491 Citations
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Introduction
Additional affiliations
January 2009 - present
University of Nottingham
Position
  • Lead Director
January 2000 - present
Nottingham University Hospitals NHS Trust
Position
  • Head of Department
Description
  • Professor of Gastroenterology Focus of reserach on functional GI diseases Imaging gut function using MRI Clinical trials in IBS

Publications

Publications (608)
Article
Full-text available
Objectives Persistent bowel dysfunction following gastroenteritis (postinfectious (PI)-BD) is well recognised, but the associated changes in microbiota remain unclear. Our aim was to define these changes after gastroenteritis caused by a single organism, Campylobacter jejuni , examining the dynamic changes in the microbiota and the impact of antibi...
Article
Full-text available
Irritable bowel syndrome (IBS) is a gut-brain disorder of multifactorial origin. Evidence of disturbed serotonergic function in IBS accumulated for the 5-HT3 receptor family. 5-HT3Rs are encoded by HTR3 genes and control GI function, and peristalsis and secretion, in particular. Moreover, 5-HT3R antagonists are beneficial in the treatment of diarrh...
Conference Paper
Introduction/Background Functional constipation (FC) in childhood is common, with a prevalence estimated around 10%. To date, relatively little is known about colonic volume in children with FC. Aim The primary aim of this study was to measure colonic volume in children of different ages with FC and also provide initial normal range values for hea...
Article
Full-text available
Background: Single-nucleotide polymorphisms (SNPs) of the serotonin type 3 receptor subunit (HTR3) genes have been associated with psychosomatic symptoms, but it is not clear whether these associations exist in irritable bowel syndrome (IBS). Aim: To assess the association of HTR3 polymorphisms with depressive, anxiety, and somatization symptoms...
Article
Full-text available
Background New developments in MRI have allowed the non-invasive, accurate measurement of the small bowel water content (SBWC). Aims To collate studies measuring SBWC following ingestion of a range of foods in both health and disease to provide data for adequately powering future studies in this area. Methods This collation brings together 29 stu...
Article
Full-text available
Oral specially coated formulations have the potential to improve treatment outcomes of a range of diseases in distal intestinal tract whilst limiting systemic drug absorption and adverse effects. Their development is challenging, partly because of limited knowledge of the physiological and pathological distal gastrointestinal factors, including col...
Article
People with cystic fibrosis (CF) experience digestive symptoms but the mechanisms are incompletely understood. Here we explore causes and consequences of slower gastrointestinal transit using magnetic resonance imaging (MRI). Twelve people with CF and 12 healthy controls, matched for age and gender, underwent MRI scans, both fasted and after standa...
Article
Full-text available
Irritable bowel syndrome (IBS) results from disordered brain–gut interactions. Identifying susceptibility genes could highlight the underlying pathophysiological mechanisms. We designed a digestive health questionnaire for UK Biobank and combined identified cases with IBS with independent cohorts. We conducted a genome-wide association study with 5...
Article
Full-text available
Objective Health-promoting dietary fibre including inulin often triggers gastrointestinal symptoms in patients with IBS, limiting their intake. Our aim was to test if coadministering psyllium with inulin would reduce gas production. Design A randomised, four-period, four-treatment, placebo-controlled, crossover trial in 19 patients with IBS. Subje...
Article
Full-text available
Irritable bowel syndrome (IBS) is a gut‐brain disorder in which symptoms are shaped by serotonin acting centrally and peripherally. The serotonin transporter gene SLC6A4 has been implicated in IBS pathophysiology, but the underlying genetic mechanisms remain unclear. We sequenced the alternative P2 promoter driving intestinal SLC6A4 expression and...
Article
Background/aims: Diarrhea-predominant irritable bowel syndrome (IBS-D) has been previously associated with evidence of immune activation and altered microbiota. Our aim is to assess the effect of the anti-inflammatory agent, mesalazine, on inflammatory gene expression and microbiota composition in IBS-D. Methods: We studied a subset of patients...
Article
Introduction: Despite heterogeneity, an increased prevalence of psychological comorbidity and an altered pronociceptive gut microenvironment have repeatedly emerged as causative pathophysiology in patients with irritable bowel syndrome (IBS). Our aim was to study these phenomena by comparing gut-related symptoms, psychological scores, and biopsy s...
Preprint
Cystic fibrosis (CF) is a genetic disease affecting mucosal secretions. Most patients experience digestive symptoms, but the mechanisms are incompletely understood. Here we explore causes and consequences of slower gastrointestinal transit using magnetic resonance imaging (MRI). Twelve people with CF and 12 healthy controls, matched for age and gen...
Article
Full-text available
Irritable bowel syndrome (IBS), with its key features of abdominal pain and disturbed bowel habit, is thought by both patients and clinicians to be strongly influenced by diet. However, the complexities of diet have made identifying specific food intolerances difficult. Eating disorders can masquerade as IBS and may need specialist treatment. While...
Article
Full-text available
Background Chronic constipation is a prevalent disorder that affects quality of life of patients and consumes resources in healthcare systems worldwide. In clinical practice, it is still considered a challenge as clinicians frequently are unsure as to which treatments to use and when. Over a decade ago, a Neurogastroenterology and Motility journal...
Conference Paper
Introduction Patients with irritable bowel syndrome (IBS) often develop symptoms of gas and flatulence after intake of the prebiotic inulin, leading to dietary avoidance that may have deleterious effects on gut microbiota. Our aim was to determine if co-administering inulin with psyllium, a viscous virtually non-fermentable fibre, known to improve...
Conference Paper
Full-text available
Background RECLAIM is a multicentre study examining patients with functional constipation (FC) and IBS with constipation (IBS-C), along with healthy volunteers (HV) to correlate MRI findings with those from colonic manometry, and clinical response. We performed an interim analysis of MRI data collected so far to assess the colonic response to an os...
Conference Paper
Introduction Lactulose is widely perceived as an osmotic laxative which increases small bowel water content but its impact on large bowel water content is unclear. Ondansetron has been shown to slow left sided colonic transit but whether this is due to reduced secretions, enhanced absorption or solely altered motility is unknown. Our aim was to tes...
Article
Full-text available
Objective The gastrointestinal environment in which drug products need to disintegrate before the drug can dissolve and be absorbed has not been studied in detail due to limitations, especially invasiveness of existing techniques. Minimal in vivo data is available on undisturbed gastrointestinal motility to improve relevance of predictive dissoluti...
Article
Full-text available
Objective: In England, 27,500 children are referred annually to hospital with constipation. An objective measure of whole gut transit time (WGTT) could aid management. The current standard WGTT assessment, the x-ray radiopaque marker (ROM) test, gives poor definition of colonic anatomy and the radiation dose required is undesirable in children. Ou...
Article
Background: Whole apples produce greater satiety than processed apples, but the underlying mechanisms remain unclear. Objective: Our aim was to assess the intragastric processing of apple preparations and the associated small and large bowel contents using MRI. Methods: An open label, 3-way crossover, randomized, controlled trial. Eighteen hea...
Article
Full-text available
Background Magnetic resonance imaging (MRI) of the colonic response to a macrogol challenge drink can be used to assess the mechanisms underlying severe constipation. We measured the intrasubject reproducibility of MRI measures of colonic function to aid their implementation as a possible clinical test. Methods Healthy participants attended for MR...
Article
Background: Wheat bran, nopal, and psyllium are examples of particulate, viscous and particulate, and viscous fibers, respectively, with laxative properties yet contrasting fermentability. Objectives: We assessed the fermentability of these fibers in vitro and their effects on intestinal function relevant to laxation in vivo using MRI. Methods:...
Article
Background Cystic fibrosis (CF) is a multi-system genetic disorder affecting >72,000 people worldwide. Most CF patients experience gastrointestinal symptoms and can develop complications. However, the mechanisms of CF gut disease are not well understood. We evaluated gut function and transit in CF using magnetic resonance imaging (MRI). We hypothes...
Article
Full-text available
Measurement of gastric emptying is of clinical value for a range of conditions. Gamma scintigraphy (GS) has an established role, but the use of magnetic resonance imaging (MRI) has recently increased. Previous comparison studies between MRI and GS showed good correlation, but were performed on separate study days. In this study, the modalities were...
Preprint
Background and Aims Cystic fibrosis (CF) is a multi-system genetic disorder affecting >72,000 people worldwide. Most people with CF experience gastrointestinal symptoms and some will develop complications such as distal intestinal obstruction syndrome. However the mechanisms of symptoms and complications are not understood. We evaluated gut functio...
Article
Full-text available
LINKED CONTENT This article is linked to Gunn et al and Black et al papers. To view these articles, visit https://doi.org/10.1111/apt.15420 and https://doi.org/10.1111/apt.15455.
Article
Full-text available
Background: Crohn's disease (CD) patients suffer postprandial aversive symptoms, which can lead to anorexia and malnutrition. Changes in the regulation of gut hormones and gut dysmotility are believed to play a role. Objectives: This study aimed to investigate small-bowel motility and gut peptide responses to a standard test meal in CD by using...
Article
Full-text available
Background: Irritable bowel syndrome with diarrhoea (IBS-D) is a common condition, greatly reducing the quality of life with few effective treatment options available. Aims: To report the beneficial response shown in our trial with the 5-hydroyxtryptamine (5-HT) receptor 3 antagonist, ondansetron in IBS-D METHODS: A randomised, placebo-controlle...
Article
Full-text available
Background: Irritable bowel syndrome with diarrhoea (IBS-D) affects up to 4% of the general population. Symptoms include frequent, loose, or watery stools with associated urgency, resulting in marked reduction of quality of life and loss of work productivity. Ondansetron, a 5HT3 receptor antagonist, has had an excellent safety record for over 20 y...
Article
Whole grain cereal breakfast consumption has been associated with beneficial effects on glucose and insulin metabolism as well as satiety. Pearl millet is a popular ancient grain variety that can be grown in hot, dry regions. However, little is known about its health effects. This study investigated the effect of a pearl millet porridge (PMP) compa...
Article
Full-text available
Alterations in colonic motility are implicated in the pathophysiology of bowel disorders, but high-resolution manometry of human colonic motor function has revealed that our knowledge of normal motor patterns is limited. Furthermore, various terminologies and definitions have been used to describe colonic motor patterns in children, adults and anim...
Article
Background and aims: The regular overnight migrating motor complex (MMC) ensures that the normal fasting small-bowel water content (SBWC) is minimised. We have applied our recently validated non-invasive magnetic resonance technique to assess SBWC in newly diagnosed coeliac disease (CD), scleroderma (SCD) and irritable bowel syndrome (IBS), condit...
Article
Full-text available
Understanding how the gut responds to food has always been limited by the available investigatory techniques. Previous methods involving intubation and aspiration are largely limited to liquid-only meals. The aim of this review is to describe how MRI has allowed analysis of the processing of complex multiphase meals. This has demonstrated the role...
Article
Full-text available
Background Complications of diverticular disease are increasingly common, possibly linked to increasing obesity. Visceral fat could contribute to the development of symptomatic diverticular disease through its pro-inflammatory effects. Objective The study had 2 aims. A) to develop a semi-automated algorithm to measure abdominal adipose tissue from...
Article
Small intestinal function is critical to digestive health and patients believe an abnormal reaction to food is responsible for many of their symptoms. Despite this, our ability to assess disturbed function in clinical practice has been limited, particularly after ingestion of the complex nutrients which make up normal food. Recent advances in both...
Article
Colonic diverticula are formed by mucosal outpouching from the colonic wall. Their presence increases with increasing age with most, in Caucasian, being situated in the left colon. The aetiology of these outpouchings is not fully understood but dietary, lifestyle and genetic factors have all been implicated. Most patients with diverticula are asymp...
Article
Magnetic resonance imaging (MRI) is a well established technique that has revolutionized diagnostic radiology. Until recently, the impact that MRI has had in the assessment of gastrointestinal motor function and bowel fluid distribution in health and in disease has been more limited, despite the novel insights that MRI can provide along the entire...
Article
Full-text available
Background Chronic constipation affects approximately 17% of the population worldwide and remains an important unmet need since patients are often dissatisfied with treatment. Kiwifruit may offer an alternative to traditional laxatives and have been shown to increase stool volume, frequency and improve consistency. Aims Using non‐invasive MRI tech...
Article
Full-text available
Background MRI is increasingly used to objectively assess gastrointestinal motility. However, motility metrics often do not offer insights into the nature of contractile action. This study introduces a systematic method of making spatio‐temporal measurements of contractions, based on changes in bowel lumen diameter. Methods Two heterogeneous cohor...
Article
Full-text available
Psyllium is a widely used treatment for constipation. It traps water in the intestine increasing stool water, easing defaecation and altering the colonic environment. We aimed to assess the impact of psyllium on faecal microbiota, whose key role in gut physiology is being increasingly recognised. We performed two randomised, placebo-controlled, dou...
Article
Full-text available
Glycaemic, gastrointestinal, hormonal and appetite responses to pearl millet and oats porridge breakfast: a randomized, crossover trial - Volume 77 Issue OCE4 - Jaber Alyami, Ella Whitehouse, Susan E. Pritchard, Caroline L. Hoad, Khaled Heissam, Elaine Blackshaw, Sally Cordon, Robin C. Spiller, Penny A. Gowland, Ian A. Macdonald, Guruprasad P. Aith...
Article
Full-text available
Background: Clostridium difficile infection (CDI) recurs after initial treatment in approximately one in four patients. A single-centre pilot study suggested that this could be reduced using 'follow-on' rifaximin treatment. We aimed to assess the efficacy of rifaximin treatment in preventing recurrence. Methods: A multisite, parallel group, rand...
Article
Full-text available
Background & aims Ingestion of poorly digested, fermentable carbohydrates (fermentable oligo-, di-, mono-saccharides and polyols; FODMAPs) have been implicated in exacerbating intestinal symptoms and the reduction of intake with symptom alleviation. Restricting FODMAP intake is believed to relieve colonic distension by reducing colonic fermentation...
Data
Details of food package contents. Food package contents provided to study subjects 24 hours prior to MRI scan for baseline (standard food package) and post-intervention (low FODMAP food package). (PDF)
Data
Variation in microbial taxa with gas groupings. Data is either shown as relative abundance (% total) for bacteria or amount of the Methanobrevibacter specific nifH-gene per μg template DNA. Gas groupings were defined according to cut-off values; >20 ppm hydrogen and <20 ppm methane (Hydrogen), >20 ppm methane and <20 ppm hydrogen (Methane), >20 ppm...
Data
Associations between colonic volume and other variables. Data for both time points is shown with linear model fits as lines and shaded areas representing 95% confidence intervals. A) Colonic volume correlates with transit (WAPS) at baseline (r = 0.43, p<0.01), post-intervention (r = 0.37, p<0.05) and overall (r = 0.43, p<0.01). B) Colonic volume co...
Data
Detailed dietary breakdown. Table of mean daily intake for individual dietary components. The intervention supplements are not included. MD, maltodextrin; OF, oligofructose; BL, baseline; PI, post-intervention. SD values given in brackets. Values which differ significantly from baseline are shown in bold. (PDF)
Data
Variation in urinary metabolite profiles between groups. Principal Coordinates Analysis of urinary metabolite profiles showing separation between baseline and post-intervention samples. BL = baseline, MD = maltodextrin, OF = oligofructose. (TIF)
Data
Supplementary methods. Detailed description of methods for dietary and metabolomics analysis. (PDF)
Data
Detailed study protocol. (PDF)
Data
Detailed microbiota changes. Complete list of significant genus level changes post-intervention compared to the baseline. FDR corrected p-values >0.05 are show in bold. (PDF)
Data
Faecal short chain fatty acid concentrations. Short chain fatty acid concentrations per study group. MD, maltodextrin; OF, oligofructose; BL, baseline; PI, post-intervention. No significant differences between the groups. Values shown are mean (SD) μmol/g wet stool per group. (PDF)
Data
R script for microbiota testing. R script for comparing the microbiota to categorical and continuous variables using the package Microbiota Analysis in R Easily (mare). Viewable with any text editor. (R)
Data
Associations between the microbiota and short chain fatty acids. Statistically significant associations between genus level taxa and short chain fatty acids, across both time points, showing positive or negative associations calculated with linear mixed models. (PDF)
Data
Full output of microbiota comparison by study group. Tabulated output from the GroupTest function within mare indicating relative abundance, fold change, raw and corrected p-values for all identified genera by study group. (XLSX)
Conference Paper
Full-text available
Introduction Intestinal inflammation in Crohn’s disease (CD) is associated with an increase in Polypeptide YY (PYY), Glucagon-like peptide 1 (GLP-1) and cholecystokinin (CCK). CD patients experience postprandial fullness and nausea. These symptoms may be linked to the increase in plasma gut peptides levels and alterations in intestinal motility.Our...
Article
Background In functional gastrointestinal disorders a lack of objective biomarkers limits evaluation of underlying mechanisms. We aimed to demonstrate the utility of magnetic resonance imaging for this task using psyllium, an effective constipation treatment, in patients and controls. Methods Two crossover studies: (i) adults without constipation...