The following blog is a summary of key learning points from a talk given at Digestive Health and Wellbeing: The Patient Journey.

Click here to learn more about the event or click here to visit the healthcare professionals portal.

Meet the speaker:

Dr Anthony Hobson is an internationally renowned Consultant Clinical Scientist with experience across the NHS and private healthcare sectors as well as in academia and the pharmaceutical industry. Trained in Manchester, Anthony built a broad base of experience in assessing gut function from ‘top to bottom’, covering important areas such as gastro-oesophageal reflux disease, Irritable Bowel Syndrome (IBS), incontinence and constipation. Anthony’s industry experience provided further training in designing and implementing clinical trials to test experimental approaches and novel treatments in conditions like IBS, an area he is still passionate about.

Anthony’s longstanding vision is that the highest quality Gastro-Intestinal Physiology testing should be available to all patients, and as such, he has set up mobile clinics with several NHS centres to provide these services. His work has been recognised as advancing the field of GI Physiology winning several prestigious awards including the Department of Health and Chief Scientific Officer’s ‘Young Healthcare Scientist’ of the year. Anthony has also been awarded the Functional Gut-Brain Young Investigator award (United States) and the EFIC Grunethal Young Investigator in Pain award (Germany).

Tertiary care of digestive health patients

Anthony’s presentation explains the different tests that patients with digestive health issues commonly undertake and the impact on clinical decision making. Anthony identifies the time for patients to get referred for testing and what tests are available to them. The presentation also discusses what these tests can tell healthcare professionals about gut function and how this can be implemented into practice for effective decision making and management.

Summary points

What do we mean by tertiary care pathways in gut health? This is the route taken when:

  • Red flags and alarms have been excluded by doctors in the primary and secondary stages of care
  • Diet and lifestyle options have been fully explored
  • Empirical medical treatments have been unsuccessful
  • Patient’s quality of life is still significantly impaired

In tertiary care, objective diagnostic evidence is used to guide management and support decision-making. The Functional Gut clinic was established in 2013 and maintains an active R&D programme, seeing over 5000 patients a year.

The Functional Gut clinic focuses on 7 areas:

  1. Ingestion
  2. Digestion
  3. Transit
  4. Fermentation
  5. Continence
  6. Defecation
  7. Behaviours

The organisation uses biomarkers, recognises their functional consequence and looks at them in terms of function and symptoms. A multidisciplinary team approach is used to make decisions based on these diagnostic tests. One of the most interesting developments is the creation of a positive diagnostic strategy rather than an exclusion strategy for IBS. This approach aims to better understand what IBS is and how it can be treated, much of which still remains unknown. This strategy includes utilising smart pills to work out what is happening in the bowel during a meal, such as alterations in temperature, pressure and pH.

Small intestinal bacteria overgrowth (SIBO) is a condition affecting the small intestine, when bacteria normally found in other parts of the gut are found here. Through tertiary care testing, this can be measured with breath tests and other investigations. There will be fermentation happening in the small intestine and even the easily digested carbohydrates start to become fermented, rather than absorbed. In the future of breath testing, we are aiming to characterise health profiles. This will give us more targeted profiles for particular conditions, specific profiles for certain bacterial species - and may highlight approaches for better and more effective treatments.

The Functional Gut Clinic wants to prove treatment using products to demonstrate that they are appropriate for patients with specific conditions. As we continue to build learning and knowledge, outcomes of the research should be fed back into the diagnostics pathway to improve understanding. One important question to ask moving forward is ‘should diagnostics be used at an earlier stage of the gut health pathway to help people before they have to suffer with symptoms for years?’.

Click here to visit the Bimuno HCP learning portal, which includes Anthony’s presentation.

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