Simon Campbell

• MB ChB FRCP(Lon) MD(Edin)
• Lecturer at The University of Manchester

Background & aims: DNA methylation alterations may provide important insights into gene-environment interaction in cancer, aging and complex diseases such as inflammatory bowel disease (IBD). We aim firstly to determine whether the circulating DNA methylome in patients requiring surgery may predict Crohn's disease (CD) recurrence following intesti...

Regulation of intestinal T-cell responses is crucial for immune homeostasis and prevention of inflammatory bowel disease (IBD). A vital cytokine in regulating intestinal T cells is transforming growth factor-β (TGFβ), which is secreted by cells as a latent complex that requires activation to function. However, how TGFβ activation is regulated in th...

Background: Up to 60% of patients with Crohn's disease need intestinal resection within the first 10 years of diagnosis, and postoperative recurrence is common. We investigated whether mercaptopurine can prevent or delay postoperative clinical recurrence of Crohn's disease. Methods: We did a randomised, placebo-controlled, double-blind trial at...

Background: Ferric maltol was effective and well-tolerated in iron deficiency anaemia patients with inflammatory bowel disease during a 12-week placebo-controlled trial. Aim: To perform a Phase 3 extension study evaluating long-term efficacy and safety with ferric maltol in inflammatory bowel disease patients in whom oral ferrous therapies had f...

Regulatory T (Treg) cells play a pivotal role in suppressing self-harmful T cell responses, but how Treg cells mediate suppression to maintain immune homeostasis and limit responses during inflammation is unclear. Here we show that effector Treg cells express high amounts of the integrin αvβ8, which enables them to activate latent transforming grow...

Foxp3+ regulatory T-cells (Tregs) play a pivotal role in suppressing self-harmful T-cell responses to prevent inflammatory disease. An important cytokine in the development and function of Tregs is TGFβ, a latent cytokine that must be activated to function. Compelling evidence suggests that T-cells need to respond to TGFβ in order for Treg-mediated...

Despite the significant impact of Crohn's disease (CD) on patients' physical and emotional well-being, no CD-specific patient-reported outcome (PRO) measure is available for determining the efficacy of interventions. The objective of the study was to develop and validate the Crohn's Life Impact Scale (CLIQ), the first such measure. Questionnaire co...

Introduction A common therapeutic strategy in events of failure of the first-line anti-TNFα biologic in Crohn’s Disease (CD) is to switch to another biologic agent from the same class. There is a significant body of evidence to support using adalimumab (ADA) as second-line therapy following infliximab (IFX) intolerance or loss of response. The aim...

Introduction Anti-Tumour Necrosis Factor alpha antibodies (anti-TNFs) are widely used for the treatment of severe and fistulising Crohn’s Disease (CD). They are, however, associated with a number of adverse events (AEs) including infections, neutropenia, malignancy, demyelinating disease and infusion reactions. We aimed to evaluate the safety profi...

Background Ulcerative colitis is a lifelong, chronic, relapsing-remitting disease. Objective To assess the relationship between ulcerative colitis disease status and patient quality of life, and to determine the impact of ulcerative colitis on healthcare costs and work productivity, in the UK. Methods Clinicians assessed 173 adult patients' current...

Introduction Crohn’s Disease (CD) is a chronic, inflammatory, autoimmune disorder that substantially impairs patients’ physical and emotional well-being. Despite this there is no CD-specific patient-reported outcome measure (PROM) available for determining the efficacy of alternative interventions for the condition. The objective of the study is to...

Introduction There is concern in the UK that services for pts with long term conditions are not orgnised to promote independence with silo working in primary and secondary care with reactive services. These may be brought together formally through the development of model of care. Utilization of current out-pt spaces to regularly review stable pts...

Introduction To determine the impact of Crohn's Disease (CD) and its treatment from the patient's perspective a high quality CD-specific PROM is required. This must have; a meaningful theoretical basis, relevant, well-targeted content derived from CD patients and unidimensional, reliable and valid scales. Aims/Background This study describes the de...

Introduction Young males with iron deficiency (IDA) routinely undergo endoscopy. There is paucity of data on the diagnostic yield of bi-directional endoscopy, level of HB that requires investigation and the yield in symptomatic vs. asymptomatic young men. We aim to study the diagnostic yield of bi-directional endoscopy in young males and the influe...

BACKGROUND AND AIMS: The rising incidence of inflammatory bowel disease (IBD) in adults and children has implications for the lifelong burden of disease and the provision of specialist services. Patients with IBD should have access to specialist care which is delivered according to their values and needs. Few studies have examined patients' views...

Background and aims: The rising incidence of inflammatory bowel disease (IBD) in adults and children has implications for the lifelong burden of disease and the provision of specialist services. Patients with IBD should have access to specialist care which is delivered according to their values and needs. Few studies have examined patients' views...

Background: Adalimumab (ADA) is a subcutaneous anti-tumour necrosis factor (anti-TNF) agent, effective in inducing and maintaining remission in Crohn's disease (CD). Unlike Infliximab (IFX), ADA dosing is not weight adjusted and dose frequency is based on clinical response. Aim: To determine whether obesity is a risk factor for early loss of res...

Introduction Equity and excellence: Liberating the NHS (2010) states that new modes of care delivery must be explored for patients with long term conditions (LTCs). Increasing the proportion of people with a LTC to self care is a Quality Indicator and High Level Outcome in the Health and Well Being Strategy. The increasing focus on self care and re...

Introduction Many patients with IBD in the UK are managed primarily in secondary care with minimal General Practitioner (GP) involvement or within a restricted shared care protocol. As UK NHS hospitals face mounting financial and workforce pressures, reconfiguration of hospital services can provide a powerful means of improving the quality of patie...

Introduction Adalimumab (Humira, Abbott) is a novel subcutaneous anti-TNF agent, effective in inducing and maintaining remission in Crohn's disease (CD). Unlike Infliximab (IFx), Adalimumab (Ad) dosing is not weight adjusted, and dose frequency is based on clinical response. Pharmacokinetic analyses in rheumatoid arthritis patients (pts) has shown...

Introduction Research into the impact of Crohn's Disease (CD) and its treatment on the patient relies on outdated and inappropriate generic questionnaires. These do not address important impacts of the illness and ask questions of limited relevance. As part of a study to develop CD-specific patient-reported outcome measures (PROMS), qualitative int...

Over the past years, mucosal healing has emerged as a major therapeutic goal in clinical trials in inflammatory bowel diseases. Accumulating evidence indicates that mucosal healing may change the natural course of the disease by decreasing the need for surgery and reducing hospitalization rates in both ulcerative colitis and Crohn's disease. Mucosa...

IntroductionMorbidity surrounding Coeliac disease is usually a consequence of malabsorbtion of minerals and vitamins leading to anaemia and metabolic bone disease. In January 2002 a Dietetic led clinic was introduced at Manchester Royal Infirmary to improve patient care. We conducted an audit to compare the practice of the initial management of Coe...

Isolated abdominal pain is seen as a poor indication for colonic investigations. The yield of serious pathology detected by optical colonoscopy (OC) has differed greatly in published series. This study aims to establish the yield of colonic investigations for isolated abdominal pain. A retrospective analysis of the endoscopy database was undertaken...

Azathioprine (AZA) is commonly used in inflammatory bowel disease (IBD) patients. Lymphopenia is a recognized effect of this treatment, but lymphopenia-related complications in IBD patients have not been widely reported. The incidence and progression of AZA-induced lymphopenia in IBD patients is not well described. There is no consensus on its opti...

Introduction Metabolomics is a powerful scientific strategy which identifies low molecular weight (bio)chemicals (metabolites) present in the metabolome of a cell, tissue or organism. The aim of this study was to undertake a two-stage metabolomic study of circulatory serum from patients with ulcerative colitis (UC) and Crohn's disease (CD) and matc...

Variants in the interleukin-23 receptor (IL23R) and the autophagy-related 16-like 1 (ATG16L1) genes have been associated with an increased risk of Crohn's disease (CD). Both genes were identified through genome-wide association scans and subsequent studies have validated these associations. To assess the effect size of these variants, an independen...

Introduction A significant proportion of Crohn's disease (CD) patients have been treated with two biologic therapies. Follow-up from current published retrospective or prospective open-label studies on patients who have already received 2 biologics does not extend beyond 1 year (1-4). Methods Our aim was to collect “real-life”, long-term data on th...

A 39-year-old Afro-Caribbean man with Crohn disease with recurrent deep vein thromboses and pulmonary emboli was commenced on lifelong warfarin treatment. The patient required high-dose warfarin (>140 mg/wk), which increased further during azathioprine treatment. Cessation of azathioprine resulted in an increase in the international normalized rati...

The use of tumour necrosis factor antagonists have revolutionized the modern approach to the management of Crohn's disease, and with two proven therapies available in the UK (adalimumab and infliximab), the concept of patient choice is now being considered to assist in determining which therapy to use with each individual patient. While offering pa...

When surgery is necessary in patients with ulcerative colitis, total proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the procedure of choice. Several inflammatory and noninflammatory complications can occur after IPAA. Pouchitis is the most common, occurring in approximately 50% of patients. Whereas "acute" pouchitis can be treated rapi...

Adalimumab is effective in inducing and maintaining response/remission in patients with Crohn's disease either naive to biological therapies or after secondary failure of infliximab. To present the first 'real-life' survey data from England and Ireland on the use of adalimumab. A retrospective audit conducted through a web-based questionnaire in En...

Infliximab is used for treatment of Crohn's disease and, following the Active Ulcerative Colitis Trials (ACT) 1 and 2, it has been used as rescue and maintenance therapy in moderate and severe ulcerative colitis (UC). To report on English experience with maintenance infliximab in terms of response and colectomy rates and side-effect profile in UC....

Well-designed studies that help guide physicians to apply the optimal therapeutic strategy for the management of pyoderma gangrenosum are lacking in the literature. A multidisciplinary approach is paramount for the effective management of this condition, with close involvement of a wound-care specialist and a microbiologist. Treatment should be ste...

Within a lifetime, approximately 15% of ulcerative colitis (UC) patients will have a severe relapse necessitating admission to hospital. Despite intravenous steroid treatment, approximately 25% will require either surgery or ciclosporin (CsA) rescue therapy. Initial response rates to CsA have been encouraging, but remission rates have been disappoi...

Context: Intussusception in adults is rare, accounting for 0.1% of adult hospital admissions. In contrast to this, it is the leading cause of obstruction in children. In up to 90% of adults a cause can usually be found, but in children this is rarely the case. Case report: We report the case of a 27-year-old lady with a subacute bowel obstructio...

We have identified miss-sense mutations in keratin 8 in a subset of patients with inflammatory bowel disease (Crohn disease and ulcerative colitis). Inflammatory bowel diseases are a group of disorders that are polygenic in origin and involve intestinal epithelial breakdown. We investigated the possibility that these keratin mutations might contrib...

Cardiac sinus syncope is a recognised but rare complication of head and neck cancers. Although electrical pacing remains an important treatment to prevent further syncopal episodes related to bradycardia, vasopressor-related syncope remains a more difficult management problem. The article describes the case of a 66-year-old patient with metastatic...

Background: Cyclosporine is a fungal metabolite and a powerful immunosuppressant. While response to intravenous steroids in severe ulcerative colitis is in excess of 60%, the remainder of patients are left with the options of curative panproctocolectomy or administration of intravenous rescue therapy with cyclosporine. There have been conflicting...

Celiac disease is a T cell-mediated enteropathy induced by gluten in genetically predisposed individuals. The majority of patients responds to a gluten-free diet but a small number do not. After the exclusion of gluten in the diet, ulcerative jejunititis, and an enteropathy-associated T-cell lymphoma, another treatment modalities, such as systemic...

It is well-recognized that patients with low thiopurine methyltransferase activity are more susceptible to the development of bone marrow suppression side-effects. To study the impact of thiopurine methyltransferase activity on the clinical course of inflammatory bowel disease patients treated with low-dose azathioprine (< 2 mg/kg). We measured the...

The risk of development of colon cancer in patients with ulcerative colitis is an emotive issue with patients and a potential medico-legal problem for physicians caring for such patients. The exact magnitude of the risk is not clearly defined. Current surveillance programmes use dysplasia as a marker for the risk of invasive carcinoma development,...

To assess the effect of 5-aminosalicylate treatment in conjunction with azathioprine on remission maintenance in inflammatory bowel disease patients. This retrospective study was based on a total of 186 inflammatory bowel disease patients (104 with Crohn's disease; 82 with ulcerative colitis), who were stable on azathioprine for a minimum of 6 mont...

Azathioprine is an effective treatment for maintaining remission in inflammatory bowel disease (IBD). It is a matter of debate as to whether neutropenia is required during azathioprine therapy to achieve more effective disease remission. We evaluated whether neutropenia during azathioprine therapy reduced relapse rates in IBD patients. This retrosp...

Treatment of Crohn's disease with infliximab is an important drug therapy for patients with refractory and fistulating disease. There are concerns over its use in a proportion of Crohn's patients with concurrent hepatitis C infection, since there are theoretical risks of accelerated hepatic decompensation due to the immunomodulatory impact of infli...

Retrosternal heartburn is acknowledged to be the archetypal symptom of gastroesophageal reflux disease and is usually associated with demonstrable reflux of acid gastric contents to the esophagus. A minority of patients who suffer heartburn do not have abnormally excessive esophageal acid exposure, however, and the term functional heartburn has bee...

Extravasation of chyle from the intestinal lymphatics into the peritoneal cavity results in chylous ascites, identified by its characteristic milky appearance. Chylous ascites is rare, but it has been suggested that its incidence may be increasing in the adult population. Successful management depends on identifying the underlying cause of the lymp...

Intestinal pseudo-obstruction is a recognized but rare complication of chemotherapy. Vinca alkaloids and cytarabine have been reported to be associated with intestinal pseudo-obstruction. We report a case of fludarabine induced severe intestinal pseudo-obstruction in a 66-year-old man suffering from non-Hodgkin's lymphoma, and describe our successf...

: Intestinal pseudo-obstruction is a recognized but rare complication of chemotherapy. Vinca alkaloids and cytarabine have been reported to be associated with intestinal pseudo-obstruction. We report a case of fludarabine induced severe intestinal pseudo-obstruction in a 66-year-old man suffering from non-Hodgkin's lymphoma, and describe our succes...