Current Projects

This national cross-sectional survey explores how point-of-care ultrasound (POCUS) is currently used, taught, and perceived among UK gastroenterology trainees. Despite adoption of POCUS in other medical specialties, its role within gastroenterology training remains poorly defined. This study aims to evaluate registrar exposure to ultrasound training, access to equipment, and confidence in its clinical use across common and less common scenarios, including ascites assessment and procedural guidance.

The project will also investigate barriers to training, regional variation in access, and cultural attitudes toward ultrasound adoption. Using an anonymous online survey, the study seeks to generate robust data to inform future curriculum development. Findings will help identify gaps in training provision and support the case for integrating ultrasound more formally into gastroenterology practice and education across the UK.

Method: Multi-centre retrospective cohort analysis of medical records

Inclusion criteria:

1. Confirmed IBD (Crohn’s disease, ulcerative colitis, or IBD-unclassified) per standard classification.
2. Adults (≥18 years) and children (0–18 years)
3. Concurrent use of two biologics, or one biologic + one small molecule, for at least 4 weeks

Exclusion criteria:

1. Single therapy (monotherapy) or small molecule-only combinations
2. Biologics used only for non-IBD reasons (e.g. psoriasis alone)

Primary Outcome

1. To describe current real-world clinical practice in the use of dual advanced therapy (DAT) — i.e. concurrent use of two biologic agents, or a biologic plus a targeted small molecule — for the treatment of inflammatory bowel disease (IBD) across multiple NHS Scotland health boards
2. To determine the main clinical indications for initiating DAT, including refractory luminal disease, uncontrolled extraintestinal manifestations, and co-existing immune-mediated inflammatory diseases
3. To assess the extent to which DAT prescribing in NHS Scotland aligns with international IBD guidelines and best-practice recommendations (including ECCO position statements, published systematic reviews, and relevant safety/monitoring standards), in the absence of specific national or BSG guidance on dual advanced therapy
4. To evaluate key safety processes, including: Pre-treatment infection screening; Vaccination status and documentation, Evidence of multidisciplinary team (MDT) discussion prior to starting dual advanced therapy
5. To examine monitoring practices during DAT, including use of therapeutic drug monitoring (TDM) where applicable, frequency of routine blood tests, and surveillance for adverse events
6. To report clinical outcomes at defined time points (e.g. 12, 24 and 48 weeks), including: o Achievement of clinical remission, Changes in objective markers of inflammation (CRP, faecal calprotectin, endoscopic / radiological findings); Rates of steroid tapering, hospital admissions, new surgeries, treatment discontinuations, and serious adverse events
7. To identify any gaps in current practice, documentation, or outcomes compared with published international literature and guideline expectations.
8. To provide actionable recommendations to participating NHS boards and the Scottish Society of Gastroenterology to improve consistency, safety, and quality of care for patients receiving dual advanced therapy for IBD in Scotland.

Method: Multi-centre retrospective cohort analysis of medical records

Cohort: Patients on JAKi (filgotinib and tofacitinib) for the treatment of UC

Inclusion criteria:

1. Diagnosis of UC or IBDU favouring UC
2. Symptoms attributed to active UC plus objective evidence of inflammation (CRP≥5, FC ≥250mcg/g, active inflammation on endoscopy / imaging)
3. Minimum of 8-weeks follow up

Primary Outcome (week 8-12, week 26 and week 52):

1. Rates of clinical remission (Partial Mayo <2 or SCCAI <5)

Secondary Outcomes (week 8-12, week 26 and week 52):

1. Rates of biochemical remission (CRP <5 + FC <250mcg/g)
2. Rates of mucosal healing (Endoscopic Mayo 0 or 1)
3. Drug persistence
4. IBD specific hospitalisation
5. Colectomy rates
6. Steroid use
7. Rates of dose escalation (tofacitinib only)
8. Safety and adverse events (inc. DVT, PE and malignancy)
9. Predictors of effectiveness
10. Comparative effectiveness between JAKi based on propensity score matching (if numbers allow)

Ethics: Caldicott approval will be required for data collection and dissemination. Scotland-wide approval will be applied for to avoid need for multiple site approvals.

Future work: The database can then be re-utilised for a second phase project to collect the same outcomes for upadacitinib which is now approved