Qasim Aziz

Queen Mary, University of London, Londinium, England, United Kingdom

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Publications (269)2371.18 Total impact

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    ABSTRACT: Introduction: Chronic nausea and vomiting have a detrimental impact on quality of life. When standard diagnostic investigations fail to provide a definitive diagnosis, patients are often attributed as having a functional gastrointestinal disorder such as cyclic vomiting syndrome. Cannabinoid hyperemesis syndrome (CHS) is a relatively recently described entity presenting with symptoms similar to cyclic vomiting syndrome. Methods: We carried out a retrospective cohort study of all patients attending a tertiary neurogastroenterology and secondary care gastroenterology clinic from 2013 to 2015. Data were obtained by review of clinical notes, letters and electronic patient records. Results: We identified 10 cases of CHS (five men, mean age 27 years, range 19-51), who hitherto had been labelled with a variety of alternative diagnoses. All patients had symptoms that were episodic and refractory to medical therapy. Patients had experienced symptoms for a mean of 19.3±11.09 months before diagnosis. The median length of cannabinoid use was 42 months (interquartile range: 15-81.8). Eight patients (80%) had a history of compulsive hot water bathing (hydrophilia). The patients had a median follow-up of 9.5 months (range 1-20), during which symptoms recurred in three patients who returned to regular cannabis use. Conclusion: CHS is an underappreciated cause of recurrent nausea and vomiting and is frequently misdiagnosed. Healthcare providers should have a low index of suspicion for diagnosing CHS and the clinical history in such patients should routinely include direct questioning on cannabis use. The prognosis is very good upon cessation of cannabis intake.
    No preview · Article · Oct 2015 · European journal of gastroenterology & hepatology
  • S A Slattery · O Niaz · Q Aziz · A C Ford · A D Farmer

    No preview · Article · Sep 2015 · Alimentary Pharmacology & Therapeutics
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    ABSTRACT: Consensus on standard methods to assess chronic abdominal pain in patients with irritable bowel syndrome (IBS) is currently lacking. To systematically review the literature with respect to instruments of measurement of chronic abdominal pain in IBS patients. Systematic literature search was performed in PubMed/Medline databases for studies using pain measurement instruments in patients with IBS. One hundred and ten publications were reviewed. A multitude of different instruments is currently used to assess chronic abdominal pain in IBS patients. The single-item methods, e.g. the validated 10-point numeric rating scale (NRS), and questionnaires assessing gastrointestinal symptoms severity, focus mostly on the assessment of only the intensity of abdominal pain. Of these questionnaires, the validated IBS-Symptom Severity Scale includes the broadest measurement of pain-related aspects. General pain questionnaires and electronic momentary symptom assessment tools have been used to study abdominal pain in IBS patients, but have not yet been validated for this purpose. The evidence for the use of provocation tests, e.g. the rectal barostat with balloon distention, for measurement of abdominal pain in IBS is weak, due to the poor correlation between visceral pain thresholds assessed by provocation tests and abdominal pain as assessed by retrospective questionnaires. The multitude of different instruments to measure chronic abdominal pain in IBS makes it difficult to compare endpoints of published studies. There is need for validated instruments to assess chronic abdominal pain in IBS patients, that overcome the limitations of the currently available methods. © 2015 John Wiley & Sons Ltd.
    Full-text · Article · Aug 2015 · Alimentary Pharmacology & Therapeutics
  • Adam D Farmer · Qasim Aziz

    No preview · Article · Aug 2015 · Pain Medicine
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    Full-text · Article · Aug 2015
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    ABSTRACT: Background The processing of discomfort and pain in the central nervous system is normally studied with experimental methods, but it is mandatory that they are reliable over time to ensure that any interventions will result in valid results. We investigated reliability of rapid balloon distension in the rectum to elicit cortical evoked potentials (CEPs) to study the reliability of central processing of visceral sensation and discomfort/pain.Methods Eighteen healthy volunteers had two series of rectal balloon distensions performed on two separate days. Individualized balloon pressure, corresponding to pain detection threshold or to the maximum possible distension (30 psi), was used. Within- and between days reliability was measured in terms of amplitudes and latencies of the CEP global field power, topography and underlying brain networks.Key ResultsThere were two prominent peaks in the CEP recordings at mean latencies of 157 and 322 ms. There were no differences in latencies or amplitudes (p = 0.3) and they passed the Bland–Altman test for reproducibility. There were no differences in topographies (p > 0.7). Brain source connectivity revealed the cingulate-operculum network as the most consistent network within and between subjects. There were no differences in the location of brain sources in this network (p = 0.9) and the source coordinates were reproducible. Finally, the cingulate source generally had higher strength than operculum source (p < 0.001).Conclusions & InferencesA reliable method to study central mechanisms underlying visceral sensation and pain was established. The method may improve our understanding of visceral pain and could be an objective method for studying efficacy of analgesics on visceral pain.
    No preview · Article · Jun 2015 · Neurogastroenterology and Motility
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    S A Slattery · O Niaz · Q Aziz · AC Ford · AD Farmer
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    ABSTRACT: Irritable bowel syndrome is a widespread disorder with a marked socioeconomic burden. Previous studies support the proposal that a subset of patients with features compatible with diarrhoea-predominant IBS (IBS-D) have bile acid malabsorption (BAM). To perform a systematic review and meta-analysis to assess the prevalence of BAM in patients meeting the accepted criteria for IBS-D. MEDLINE and EMBASE were searched up to March 2015. Studies recruiting adults with IBS-D, defined by the Manning, Kruis, Rome I, II or III criteria and which used 23-seleno-25-homotaurocholic acid (SeHCAT) testing for the assessment of BAM were included. BAM was defined as 7 day SeHCAT retention of <10%. We calculated the rate of BAM and 95% confidence intervals (CI) using a random effects model. The methodological quality of included studies was evaluated using the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2). The search strategy identified six relevant studies comprising 908 individuals. The rate of BAM ranged from 16.9% to 35.3%. The pooled rate was 28.1% (95% CI: 22.6-34%). There was significant heterogeneity in effect sizes (Q-test χ(2) = 17.9, P < 0.004; I(2) = 72.1%). The type of diagnostic criteria used or study country did not significantly modify the effect. These data provide evidence that in excess of one quarter of patients meeting accepted criteria for IBS-D have bile acid malabsorption. This distinction has implications for the interpretation of previous studies, as well as contemporaneous clinical practice and future guideline development. © 2015 John Wiley & Sons Ltd.
    Full-text · Article · Apr 2015 · Alimentary Pharmacology & Therapeutics
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    ABSTRACT: Background The overlap of unexplained gastrointestinal (GI) and somatic symptoms is well established in patients with functional gastrointestinal disorders (FGID). Joint hypermobility syndrome (JHS) is a non-inflammatory connective tissue disorder associated with GI and somatic symptoms. We aimed to determine whether there is an association between diagnosis of JHS and FGID and the impact of this association on comorbidities and quality of life (QOL).Methods Prospective case–control study in secondary care GI clinics over 2 years. JHS was assessed by the first author prior to consultation in 641 consecutive new patients. Diagnosis of FGID (cases, n = 336) or organic disorders (controls, n = 305) was established blind to JHS status. JHS prevalence was compared in cases (FGID patients) and controls (organic disorders patients). Extra-intestinal comorbidity and QOL were compared in FGID patients with and without JHS.Key ResultsJHS prevalence was higher in FGID compared to organic GI disorders (39.0% vs 27.5%, ORadj: 1.51, CI: 1.07–2.12, p = 0.02), and particularly associated with functional gastroduodenal disorders (44.1%, ORadj: 2.08, CI: 1.25–3.46, p = 0.005), specifically postprandial distress syndrome (51%, ORadj: 1.99, CI: 1.06–3.76, p = 0.03). FGID patients with JHS had increased chronic pain (23.2% vs 11.9%, p = 0.01), fibromyalgia (10.5% vs 3.1%, p = 0.01), somatization scores (13 vs 10, p < 0.001), urinary autonomic scores (30.5 vs 20.7, p = 0.03), and worse pain-related QOL scores (45.0 vs 63.5, p = 0.004).Conclusions & InferencesJHS is significantly associated with FGID, and this subgroup of patients have increased comorbidity and decreased QOL. Further research is required to understand the pathophysiological basis of this association.
    No preview · Article · Apr 2015 · Neurogastroenterology and Motility
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    ABSTRACT: The enzyme guanosine triphosphate-cyclohydrolase-1 (GCH-1) is a rate limiting step in the de novo synthesis of tetrahydrobiopterin (BH4) a co-factor in monoamine synthesis and nitric oxide production. GCH-1 is strongly implicated in chronic pain based on data generated using the selective GCH-1 inhibitor 2,4-diamino-6-hydroxypyrimidine (DAHP), and studies which have identified a pain protective GCH-1 haplotype associated with lower BH4 production and reduced pain. To investigate the role for GCH-1 in visceral pain we examined the effects of DAHP on pain behaviors elicited by colorectal injection of mustard oil in rats, and the pain protective GCH-1 haplotype in healthy volunteers characterized by esophageal pain sensitivity before and after acid injury, and assessed using depression and anxiety questionnaires. In rodents pretreatment with DAHP produced a substantial dose related inhibition of pain behaviors from 10 to 180 mg/kg i.p. (p < 0.01 to 0.001). In healthy volunteers, no association was seen between the pain protective GCH-1 haplotype and the development of hypersensitivity following injury. However, a substantial increase in baseline pain thresholds was seen between first and second visits (26.6 ± 6.2 mA) in subjects who sensitized to esophageal injury and possessed the pain protective GCH-1 haplotype compared with all other groups (p < 0.05). Furthermore the same subjects who sensitized to acid and possessed the haplotype, also had significantly lower depression scores (p < 0.05). The data generated indicate that GCH-1 plays a role in visceral pain processing that requires more detailed investigation. © 2015 John Wiley & Sons Ltd.
    Full-text · Article · Mar 2015 · Neurogastroenterology and Motility
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    ABSTRACT: The oesophagus and stomach are responsible for transporting food from the oral cavity to the small intestine in a manner that does not compromise the safety of the airway, that is relevant to the composition of the meal, and that allows for optimal absorption of nutrients. To achieve this, several control mechanisms interact to ensure that the swallowed bolus traverses the oropharynx into the oesophageal body and enters the gastric reservoir. Here the bolus undergoes mixing and is transformed into a consistency suitable for emptying through the pylorus at a rate consistent with the maximal absorptive capacity of the small intestine.
    No preview · Article · Mar 2015 · Medicine
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    ABSTRACT: Purpose of review: This review considers the role of physical therapies in osteoarthritis management, highlighting key findings from systematic reviews and randomized controlled trials published in the last 2 years. Recent findings: Three new trials question the role of manual therapy for hip and knee osteoarthritis. No between-group differences in outcome were detected between a multimodal programme including manual therapy and home exercise, and placebo in one trial; a second trial found no benefit of adding manual therapy to an exercise programme, while a third trial reported marginal benefits over usual care that were of doubtful importance. Recent trials have also found no or uncertain clinical benefits of transcutaneous electrical nerve stimulation (TENS) or acupuncture, or of valgus braces or lateral wedge insoles for pain and function in knee osteoarthritis. Available evidence suggests a small to moderate effect of exercise in comparison with not exercising for hip or knee osteoarthritis, although optimum exercise prescription and dosage are unclear. One trial also observed a delay in joint replacement in people with hip osteoarthritis. Two trials have reported conflicting findings about the effects of exercise for hand osteoarthritis. Summary: Other than exercise, recent data suggest that the role of physical therapies in the treatment of osteoarthritis appears limited.
    Full-text · Article · Mar 2015 · Pain
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    ABSTRACT: An integrated understanding of the physiological mechanisms involved in the genesis of nausea remains lacking. We aimed to describe the psychophysiological changes accompanying visually induced motion sickness, using a motion video, hypothesizing that differences would be evident between subjects who developed nausea in comparison to those that did not. A motion, or a control, stimulus was presented to 98 healthy subjects in a randomized crossover design. Validated questionnaires and visual analogue scales (VAS) were used for the assessment of anxiety and nausea. Autonomic and electrogastrographic activity were measured at baseline and continuously thereafter. Plasma vasopressin and ghrelin were measured in response to the motion video. Subjects were stratified into quartiles based on VAS nausea scores, with the upper and lower quartiles considered to be nausea sensitive and resistant respectively. 28 subjects were exposed to the motion video during functional neuroimaging. During the motion video, nausea sensitive subjects had lower normogastria:tachygastria ratio and cardiac vagal tone but higher cardiac sympathetic index in comparison to the control video. Furthermore, nausea sensitive subjects had decreased plasma ghrelin and demonstrated increased activity the left anterior cingulate cortex. Nausea VAS scores positively correlated with plasma vasopressin, left inferior frontal and middle occipital gyri activity and negatively correlated with plasma ghrelin and brain activity in the right cerebellar tonsil, declive, culmen, lingual gyrus and cuneus. This study demonstrates that the subjective sensation of nausea is associated with objective changes in autonomic, endocrine and brain networks, and thus identifies potential objective biomarkers and targets for therapeutic interventions.This article is protected by copyright. All rights reserved
    Full-text · Article · Jan 2015 · The Journal of Physiology

  • No preview · Article · Jan 2015 · Digestion
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    ABSTRACT: Eysenck proposed a ‘trait theory’ of personality, the dimensions of which encompass numerous individual qualities. Whilst the influence of neuroticism on the brain processing of pain is well described, the role of extraversion, to date, has not been systematically investigated. Our aim was to address this knowledge gap using functional magnetic resonance imaging (fMRI).Extraversion was measured in 33 healthy volunteers (17 males, mean age 29 years [range 20–53]) using the Eysenck Personality Questionnaire. fMRI data were acquired using a 3T MRI scanner during rest, pain anticipation, and painful oesophageal balloon distention. The effect of extraversion on fMRI responses was determined.Extraversion scores varied (range 6–22) and did not influence pain threshold or rating. High extraversion was associated with significantly greater activity in the left cuneus during rest (p ⩽ 0.001), and the right insula during both anticipation (p ⩽ 0.0002) and pain (p ⩽ 0.0008). Low extraversion was associated with significantly greater brain activity in the bilateral precuneus, bilateral lingual gyrus, right inferior temporal gyrus, left fusiform gyrus and left superior parietal lobule during pain anticipation (all p ⩽ 0.0001).These results suggest that extraversion is associated with differences in the brain processing of visceral pain. Future studies of visceral pain, using fMRI, should control for extraversion.
    No preview · Article · Nov 2014 · Personality and Individual Differences
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    Adam D Farmer · Qasim Aziz
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    ABSTRACT: Summary Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory systems may have an important role. The management of patients with functional abdominal pain requires a tailored multidisciplinary approach in a supportive and empathetic environment in order to develop an effective therapeutic relationship. Patient education directed towards an explanation of the pathophysiology of functional abdominal pain is in our opinion a prerequisite step and provides the rationale for the introduction of interventions. Interventions can usefully be categorised into general measures, pharmacotherapy, psychological interventions and 'step-up' treatments. Pharmacotherapeutic/step-up options include tricyclic antidepressants, serotonin noradrenergic reuptake inhibitors and the gabapentinoids. Psychological treatments include cognitive behavioural therapy and hypnotherapy. However, the objective evidence base for these interventions is largely derived from other chronic pain syndrome, and further research is warranted in adult patients with functional abdominal pain.
    Full-text · Article · Sep 2014 · Journal of the Royal Society of Medicine
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    Yasser Al Omran · Qasim Aziz
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    ABSTRACT: The interaction between the brain and the gut has been recognized for many centuries. This bidirectional interaction occurs via neural, immunological and hormonal routes, and is important not only in normal gastrointestinal function but also plays a significant role in shaping higher cognitive function such as our feelings and our subconscious decision-making. Therefore, it remains unsurprising that perturbations in normal signalling have been associated with a multitude of disorders, including inflammatory and functional gastrointestinal disorders, and eating disorders.
    Full-text · Article · Jul 2014 · Advances in Experimental Medicine and Biology
  • Adam D. Farmer · Qasim Aziz
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    ABSTRACT: The prelims comprise: Genetic factors Psychological factors Visceral hypersensitivity Inflammatory mechanisms and dietary components Food hypersensitivity Gastrointestinal microbiota Conclusion References
    No preview · Chapter · Jun 2014
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    ABSTRACT: Chronic visceral pain affects millions of individuals worldwide and remains poorly understood, with current therapeutic options constrained by gastrointestinal (GI) side effects. Visceral pain is strongly associated with inflammation and distension of the gut. Here we report that the voltage-gated sodium channel subtype NaV1.9 is expressed in half of gut-projecting rodent dorsal root ganglia sensory neurons. We show that NaV1.9 is required for normal mechanosensation, for direct excitation and for sensitisation of mouse colonic afferents by mediators from inflammatory bowel disease tissues, and by noxious inflammatory mediators individually. Excitatory responses to ATP or PGE2 were substantially reduced in NaV1.9-/- mice. Deletion of NaV1.9 substantially attenuates excitation, and subsequent mechanical hypersensitivity, following application of inflammatory soup (bradykinin, ATP, histamine, PGE2 and 5HT) to visceral nociceptors located in the serosa and mesentery. Responses to mechanical stimulation of mesenteric afferents were also reduced by loss of NaV1.9 and there was a rightward shift in stimulus-response function to ramp colonic distension. By contrast, responses to rapid, high-intensity phasic distension of the colon are initially unaffected; however run-down of responses to repeat phasic distension were exacerbated in NaV1.9-/- afferents. Finally colonic afferent activation by supernatants derived from inflamed human tissue was greatly reduced in NaV1.9-/- mice. These results demonstrate that NaV1.9 is required for persistence of responses to intense mechanical stimulation, contributes to inflammatory mechanical hypersensitivity and is essential for activation by noxious inflammatory mediators including those from diseased human bowel. These observations indicate that NaV1.9 represents a high-value target for development of visceral analgesics.
    Full-text · Article · Jun 2014 · Pain
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    ABSTRACT: Background The parasympathetic nervous system has been implicated in the pathogenesis of a number of gastrointestinal disorders including irritable bowel syndrome. Within the field, cardiometric parameters of parasympathetic/vagal tone are most commonly derived from time, or frequency, domain analysis of heart rate variability (HRV), yet it has limited temporal resolution. Cardiac vagal tone (CVT) is a non-invasive beat-to-beat measure of brainstem efferent vagal activity that overcomes many of the temporal limitations of HRV parameters. However, its normal values and reproducibility in healthy subjects are not fully described. The aim of this study was to address these knowledge gaps. Methods 200 healthy subjects (106 males, median age 28 years, range 18-59 years) were evaluated across three study centers. After attachment of CVT recording equipment, 20 min of data (resting/no stimulation) was acquired. 30 subjects, selected at random, were restudied after 1 year. Results The mean CVT was 9.5±4.16 linear vagal scale (LVS). Thus, the normal range (mean±2 standard deviations) for CVT based on this data was 1.9-17.8 LVS. CVT correlated negatively with heart rate (r=-0.6, P=0.001). CVT reproducibility over 1 year, as indexed by an intra-class correlational coefficient of 0.81 (95% confidence interval 0.64-0.91), was good. Conclusions In healthy subjects, the normal range for CVT should be considered to be 1.9-17.8 LVS and is reproducible over 1 year. Future research utilizing CVT should refer to these values although further study is warranted in patient groups.
    Full-text · Article · Jun 2014 · Annals of Gastroenterology
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    Yasser Al Omran · Qasim Aziz
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    ABSTRACT: With more than 100 studies published over the past two decades, functional brain imaging research in gastroenterology has become an established field; one that has enabled improved insight into the supraspinal responses evoked by gastrointestinal stimulation both in health and disease. However, there remains considerable inter-study variation in the published results, largely owing to methodological differences in stimulation and recording techniques, heterogeneous patient selection, lack of control for psychological factors and so on. These issues with reproducibility, although not unique to studies of the gastrointestinal tract, can lead to unjustified inferences. To obtain consistent and more clinically relevant results, there is a need to optimize and standardize brain imaging studies across different centres. In addition, the use of complementary and more novel brain imaging modalities and analyses, which are now being used in other fields of research, might help unravel the factors at play in functional gastrointestinal disorders. This Review highlights the areas in which functional brain imaging has been useful and what it has revealed, the areas that are in need of improvement, and finally suggestions for future directions.
    Full-text · Article · Jun 2014 · Nature Reviews Gastroenterology &#38 Hepatology

Publication Stats

6k Citations
2,371.18 Total Impact Points


  • 2008-2015
    • Queen Mary, University of London
      • • The Blizard Institute of Cell and Molecular Science
      • • Barts and The London School of Medicine and Dentistry
      Londinium, England, United Kingdom
    • University of Nottingham
      • Nottingham Digestive Diseases Centre
      Nottigham, England, United Kingdom
    • The University of Sheffield
      Sheffield, England, United Kingdom
  • 1997-2015
    • University of London
      Londinium, England, United Kingdom
  • 2013
    • University of Leuven
      Louvain, Flanders, Belgium
  • 1995-2013
    • The University of Manchester
      • • Centre for Gastrointestinal Sciences
      • • School of Biomedicine
      Manchester, England, United Kingdom
    • Research Institute of Human Movement
      Santa Barbara, California, United States
    • Aston University
      Wheaton Aston, England, United Kingdom
  • 2005
    • King's College London
      • Department of Biostatistics
      Londinium, England, United Kingdom
  • 1998-2003
    • Harvard University
      Cambridge, Massachusetts, United States
    • London Research Institute
      Londinium, England, United Kingdom
  • 2001
    • Universität Konstanz
      Constance, Baden-Württemberg, Germany
  • 2000
    • Oxford University Hospitals NHS Trust
      Oxford, England, United Kingdom
  • 1999
    • Heinrich-Heine-Universität Düsseldorf
      Düsseldorf, North Rhine-Westphalia, Germany