Questions and Answers with Consultant Gastroenterologist Professor Stephen Patchett

By Clara Caslin

Professor Stephen Patchett is a Consultant Gastroenterologist who works in Beaumont Hospital in Dublin. He also works in The Bon Secours hospitals and is an Associate Clinical Professor in the Royal College of Surgeons Dublin. He graduated from UCD and began his training in Dublin before moving to London to train in St Bartholomew's and The Royal London Hospitals. 

He was a Senior Lecturer in St Barts in 1996 and then returned to Ireland to take up his current position in Beaumont in November 1998. He has a focus on diagnostic and therapeutic gastrointestinal endoscopy and therapeutics of inflammatory bowel disease. He is the clinical lead for endoscopy services in Beaumont and The Bon Secours. He is currently the chair of the working group for the national QA programme in endoscopy and represents the College of Physicians on the QA Steering group and the Conjoint Endoscopy Curriculum development group. 

Professor Stephen Patchett

What is your role?

Consultant Gastroenterologist.

When did you realise that being a Gastroenterologist was what you wanted to do? 

When I was a second year junior doctor and started working with a very influential gastroenterologist who subsequently became my mentor.

How many IBD patients do you treat (estimate)? 

1000.

What age group are the patients you treat? 

17-85.

Are all cases different or do you see a lot of similar ones? 

Whilst there are similarities, every patient is different both in the manifestation of their disease and their approach to dealing with their illness.

What do you think people can do to help their IBD?  

Look after themselves physically and emotionally. Eat well, exercise, don’t smoke. Learn as much as they can about their disease through interaction with others and IBD societies.

Do you ever think there will ever be a cure? 

I think ultimately yes but this will be some way off. However our ability to control the disease is improving rapidly and living with IBD will not be the challenge that it use to be.

What sort of lifestyle do you tell patients is best for them? 

Important to stay active and eat well (as we all should). This is the same advice that we would give to the general population.

Do you think IBD is one of the hardest diseases to live with? 

Difficult question as there are many difficult diseases. It really depends on the severity of an individual’s disease.

What would you say to someone who was newly diagnosed? 

Apart from explaining the nature of the disease and its treatment, I would stress that in the vast majority of cases, treatment is very successful and that a very fulfilling and active life is possible. I think a positive outlook is very important.

Image Credit: beaumont.ie

Questions and Answers with Inflammatory Bowel Disease Nurse Angela Mullen

By Clara Caslin

Angela Mullen is an Inflammatory Bowel Disease specialist nurse in the Mater Misericordiae University Hospital in Dublin. She began her nursing in Mercy Hospital, School of Nursing in Cork and then attended the Royal College of Surgeons in Dublin.

Angela Mullen at a photo call for a campaign for IBD nurses to be doubled in  2018.

What is your role?

My role is an IBD specialist nurse. I manage the IBD service, which includes inpatient and outpatient support education and advice. Most of my patients are managed at home. I run an advice email and telephone service, attend outpatient clinics and arrange urgent clinical review and also coordinate all Biological, immunosuppression therapies and educate re all medical treatments.

How many patients do you have?

I have over 1500 patients and growing rapidly.

Are you the only IBD nurse in the Mater?

I am the only IBD nurse.

Do you see more cases of Crohns or Colitis?

We see a little more Colitis than Crohn's patients (but not much).

What symptoms do people with IBD have?

Symptoms vary, classically its frequency of bowel motions worse in the mornings or at night with watery diarrhoea bleeding urgency and mucus. Sometimes just pain with altered bowel habit either constipation or diarrhoea not always with blood or mucus.

Do you think we need more IBD nurses in Ireland?

We definitely need more IBD Nurses, the patient’s with IBD need access to care (sometimes rapid) and unfortunately in some practices they don’t have that.

 How severe can some cases be?

 The severest of cases can be life threatening.

Do you think more people are having surgery or is medication able to "fix" a bad flare?

Medications can certainly treat a bad flare but with the unpredictability of the disease this sometime is not enough and surgery might be the only option totally dependent on the case.

Have you seen an increase in cases of IBD over the years?

Definitely an increase and more aggressive.

How young and old have you seen patients been diagnosed?

I work in adult services but have diagnosed patients at 16-17 and at the other end in their 70’s.

Is every case different?

No two cases really are the same everyone is different. We follow international guidelines on managements and escalations of treatments but every case is individual .

Photo Credit: Fingal Independent

Questions and Answers with Professor of Biochemistry Luke O'Neill

By Clara Caslin

Luke O’Neill is a professor of Biochemistry in the School of Biochemistry and Immunology at Trinity College Dublin. He was educated there where he was awarded an undergraduate degree in Natural Sciences (Biochemistry) in 1985. He completed his postgraduate study at the University of London where he was awarded a PhD in Pharmacology. His research investigates inflammation. For largely unknown reasons it can flare up and cause a range of inflammatory diseases, like Inflammatory Bowel Disease, which remain difficult to treat. I asked him some questions about his studies and the information that he found about Inflammatory Bowel Disease.

Luke O'Neill

What is your title?

Professor of Biochemistry.

How long have you been in your field?

 30 years.

Where did your interest start in it?

In my final undergraduate year in TCD – a project on Crohn’s disease.

What can you tell me about genetics in Crohn’s and Ulcerative Colitis?

Lots of genes have been implicated in inflammatory bowel disease affecting multiple inflammatory pathways. 2 of particular interest to my own research are NOD2 and IRGM. NOD2 is a bacterial sensor, implicating bacteria in disease pathogenesis. IRGM is an inhibitor of an inflammatory pathway involving the NLRP3 inflammasome, which a company I co-founded called Inflazome is developing inhibitors of.

Is there any trends that you have noticed in these diseases?

Both are obviously inflammatory in nature, and most likely involve a disturbance in the gut bacteria. 

Is there anything in your studies that you have noticed leads to shifts of the intestinal bacterial composition in Inflammatory Bowel Disease patients?

No.

Do you think that diet has a lot to do with these diseases? 

Limited evidence of dietary involvement.

What do you think would cause there to be a disrupted immunological response to gut microbiota in genetically susceptible individuals? 

Clearly it is a disease where there is a dysfunction in the how the gut handles bacteria. This then provokes inflammation and the inflammatory process becomes unresolving – a wound that won’t heal.

What causes chronic inflammation in the gut?

Unknown – likely to be a combination of genetics and aberrant handling of gut bacteria, or some yet to be uncovered cause.

What change can be seen when patients are treated with immunosuppressant’s? 

Current therapies show some benefits (eg anti-TNF and mesalamine) but there is a desperate need for new medicines which will limit the inflammatory process locally and promote a healing response.